Dialysis Rationing and the Just Allocation of Resources: An Historical Primer

Abstract

Historically, dialysis was a rationed medical resource. Access to treatment was restricted and based on perceived medical suitability and judged social worth of the patient. With the passage of P. L. 92-603, the federal government solved the problem of access by providing dialysis to all in need. However, the federal government avoided the core issue of how to justly allocate a scarce medical resource. Today, Medicare is a major federal government expenditure vulnerable to drastic budget cuts. Given the current political climate concerning the reduction of Medicare, the purpose of this paper is to examine the early allocation of kidney dialysis, discuss the federal government’s policy reaction at that time, and begin a discussion regarding the implications of the just allocation of dialysis in the event of health care rationing.