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April 10, 1996

End-Stage Renal Disease TherapyAn American Success Story

Author Affiliations

From the Department of Medicine, State University of New York Health Science Center at Brooklyn.

JAMA. 1996;275(14):1118-1122. doi:10.1001/jama.1996.03530380060032

Continuation of the US Kidney Program Is the Issue  Congress, the president, and organized medicine are currently assessing all aspects of government expenditures for health care. Previous constraints on reducing funding for Medicare have yielded under the pressure of the announcement by Medicare's trustees that unless curtailed, Medicare will be bankrupt shortly after the turn of the century (2002).1 By law, once the Medicare fund is exhausted, no payments for hospital or any other trust-paid services may be made. I fear this threat to America's pioneer program that since 1973 has treated all citizens afflicted with end-stage renal disease (ESRD).In 1992, more than 205 000 patients were treated for ESRD in the United States with an unadjusted acceptance rate of 212 per million and a point prevalence rate on December 31, 1992, of 794 per million.2 Superficial inspection of the Medicare ESRD program indicates to some that costs