Nevertheless, the U.S. has one of the highest dialysis mortality rates in the industrialized world, according to ProPublica's findings: Approximately one in five dialysis patients dies—almost double the rate of European countries with the best outcomes.
If the U.S. system performed as well as Italy's, France's or Japan's, "thousands fewer patients would die each year," according to the report.
Investigators reviewed thousands of inspection reports, and interviewed more than 100 patients, advocates, doctors, policymakers, researchers, and industry experts. Critical to their investigation was previously unreleased CMS data—data CMS has now agreed to release, ProPublica reports.
The year-long investigation revealed "perilous lapses" in care, from unsanitary conditions to poor regulation, noting that U.S. regulators "have few tools and little will to enforce quality standards."
Why have these problems been allowed to happen? One reason, the report says, "is that kidney failure disproportionately afflicts minorities and the dispossessed."
The implications for health reform are strongly worded and dismaying: "As the United States moves to expand access to health care, dialysis offers potent lessons. Its story expresses the fears of both ends of the ideological spectrum about what can happen when the doors to care are thrown wide open: Neither government controls nor market forces have kept costs from ballooning or ensured the highest-quality care. Almost every key assumption about how the program would unfold has proved wrong."
The ProPublica series may be viewed here.