The Medicare End-Stage Renal Disease (ESRD) Program is one of the most significant developments in the history of U.S. health care and an unqualified success.
To be eligible for coverage, patients diagnosed with ESRD need to be insured under Social Security or a dependent family member of a Social Security beneficiary. ESRD patients not yet eligible for Social Security benefits usually are covered by Medicaid, which offers outpatient dialysis coverage comparable to that of Medicare.
Even illegal immigrants with ESRD can enjoy almost full benefits in such states as California, where the MediCal program provides generous dialysis treatment coverage. Thus, virtually all of the 400,000 ESRD patients in the United States have access to maintenance dialysis treatment and inpatient services regardless of age or other comorbid condition.
It is unfortunate that the 35-year-old Medicare ESRD program remains our nation’s only universal health coverage not dependent on age, albeit limited to ESRD. The program has worked well, and its success should provide the impetus for replacing our present fractured health-care financing system with one that provides universal coverage for all U.S. residents regardless of age.
Typically, most universal health-care costs are met via a single-payer health-care system or national health insurance program such as the National Health Services program in the United Kingdom or the Gesundheitskasse AOK in Germany. The United States—where more than 45 million people have no health insurance and millions more are underinsured—is the only industrialized nation not to have universal health care.
Even some developing countries have universal health care. Private health insurance premiums have become extremely expensive. In this era of financial turmoil and other historical challenges confronting our nation, it would be in our best interest to support a system of health care for all, be it a single-payer model or a subsidized alternative. The Medicare ESRD program has been working. The time has come to expand the universal coverage it provides to the rest of the uninsured population.
Kamyar Kalantar-Zadeh, MD, MPH, PhD, is Medical Director, Nephrology, Renal & Urology News, and associate professor of medicine and pediatrics, UCLA Division of Nephrology and Hypertension.