Did you know that chronic kidney disease is the ninth-leading cause of death in the United States? Or that as of the end of 2014, more than 460,000 Americans were undergoing dialysis? Do you even know what dialysis is? John Oliver broke it all down on Sunday night’s episode of Last Week Tonight, and as is often the case when he breaks things down, he is charging that a lot of money is being made by entities taking advantage of people who are desperate for help.
So what is dialysis? Dialysis is a treatment for kidney disease in which a machine extracts a patient’s blood, cleans it and then returns it to the patient’s body. “Think of it as a Brita picture for your blood, which, yes, is more disgusting than I needed to make it sound,” says Oliver.
One of the problems with dialysis is that it is very expensive. Prior to 1972, if an American couldn’t afford it, he or she died. In ’72, Richard Nixon—yes, Richard Nixon—signed a bill ensuring that the government would pay for the dialysis of anyone who needed it. Medicare now spends around $34 billion per year on dialysis.
One of the other problems with dialysis is that despite how much money is spent on it, America has “one of the industrialized world’s highest mortality rates for dialysis care,” according to ProPublica. This is largely due to for-profit dialysis centers, Oliver says, adding that they became a necessity as the number of patients increased by a factor of more than 40 since Nixon signed the bill in 1972. “We’re basically paying for a fully loaded Lamborghini and getting a drunk done on roller skates,” says Oliver in reference to the disparity between investment and the quality of care.
There are 7,000 outpatient dialysis center in the United States, 70 percent of which are owned by either DaVita or Fresenius. For the purposes of the segment, Oliver highlighted DaVita, which is the largest of these two major for-profit dialysis companies. He contends that the reason kidney disease mortality rates are so high is because companies like DaVita will cut any corner possible to turn a profit, even if it means putting the wellbeing of its patients in jeopardy. And it certainly has turned a profit: DaVita is worth $13 billion, and made $789 million in 2016.