Two companies control the marketplace

Each year, more than 63,000 Californians ― and about 650,000 people nationwide ― receive hemodialysis, the process by which a machine filters impurities from the blood when the kidneys fail.

It is clearly a big business, one created by a last-minute amendment to a Medicare bill in 1972 that in just a few paragraphs mandated coverage for dialysis for anyone who needed it. As Oliver pointed out on HBO, that makes your kidneys the only organs in your body to have universal health coverage.

Two for-profit private dialysis companies, Colorado-based DaVita Healthcare Partners and German conglomerate Fresenius Medical Care, control about 70 percent of the U.S. market. In 2015 alone, they saw a combined profit of $2.9 billion from their dialysis business. Together they operate about 3,900 locations nationwide — “roughly the same number of Target, Best Buy, and Publix Super Market stores combined,” according to The New England Journal of Medicine’s Catalyst publication last year.

For patients who need dialysis, the procedure is all that stands between them and certain death. But there is another side to dialysis ― namely, that the leading cause of death among dialysis patients has been infection, which is the impetus for the California measure.

The California bill says that low and inadequate staffing levels at dialysis centers have led to hospitalizations, medical errors, and “unnecessary and avoidable deaths.” Dialysis workers say their caseloads are too heavy, and that they sometimes feel like they’re working on a factory assembly line. They contend that there often isn’t enough time between patients to properly prepare the dialysis stations.

In one case, three patients contracted an infection at a dialysis clinic in Los Angeles County after workers didn’t adequately clean and disinfect the machines, according to a report in the American Journal of Infection Control. 

As the California bill moves toward a vote by June 2, the hope is that California will serve as a model for nationwide legislation, said Sean Wherley, spokesman for the Service Employees International Union’s United Healthcare Workers West. While eight other states have established standards for dialysis care in the form of health department regulations, California would be the first state to actually legislate those minimal care standards.

Of the 468,000 people nationwide getting dialysis, 14 percent of them are in California, according to Wherley. “Once again, California is taking a leadership role in health care by developing legislation to regulate the dialysis industry,” he said. “Judging from the resistance that the dialysis industry is mounting, there is no question that this has national implications.”

DaVita did not respond to a request for comment.

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