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Yes, Virginia, there used to be real death panels in the U.S. They were part of the health care landscape for about 10 years, from 1962-1972.

Thanks to a Washington Post opinion piece by John Buntin this morning, that bit of history has resurfaced.

Read on for a bit more about the death panels that did exist in the U.S. and to understand how they were eliminated.

What you are about to read is a bit of medical history that isn't often discussed unless you're in a category of people who are affected or who would have been affected by the death panels.

Back around 1945, a Dutch physician named Willem Kolff perfected something he'd been working on for a while, an "artificial kidney". The first one was made of 50 yards of sausage casing wrapped around a wooden drum, which was set into a salt solution. Later ones were built with orange juice cans and a clothes washing machine. Lo and behold, the contraption worked. Of course the first few patients died, but that was no different an outcome than the one they were already heading for, since they had End Stage Renal Disease (ESRD). Number 17 lived. Dr. Kolff, a great humanitarian, did not patent the dialysis machine but instead sent copies of the design all over the world.

Eventually, researches at the University of Washington developed a Teflon shunt that allowed patients to hook up to a dialysis machine, and in 1962, the Northwest Kidney Center in Seattle opened as the world's first dialysis clinic. The clinic, which was then and remains now a nonprofit institution, still had two big problem: money and scarcity. Dialysis was over $10,000 a year, and there weren't exactly a lot of machines to go around. With more and more people clamoring to get on dialysis so they could stay alive, King County instituted two committees to determine who would be able to receive dialysis. A number of criteria were instituted that had to be met before a patient would be considered. The patient had to commit to a strict diet (which is still the case), had to be on the machine for up to 45 hours a week and still be employed, and had to commit $30,000 for three years' treatments, which amounts to about $155,000 today. If the patient passed all this, he was allowed to go before the committees. The first was a vetting committee of kidney specialists who carefully selected the first 'cut' of people. If you were older than 45, you automatically were out. People with certain medical conditions such as diabetes, vascular issues (this one for good reason, as hemodialysis does tend to lead to vascular complications), or hypertension were out. So were teens and kids. And you had to be mentally prepared to handle dialysis, which was physically and emotionally demanding (still is). If you didn't make it past this committee, you died. This, then, was a death panel.

Then there was the second committee. Comprised, at least in Seattle, of a pastor, a lawyer, a union leader, a homemaker, a couple of doctors, and a businessman, it decided whether the remaining applicants, the ones who had survived the first cut, would receive dialysis. There wasn't enough capacity for them all, so the committee evaluated the applicant's "social worth". These seven people became known as the "God committee", since they would decide whether someone lived or died. Those they eliminated died. This, then, was a death panel, too.

Life Magazine caught wind of this back in 1962 and published a story on these death panels, calling them the "life and death committee". It took ten years for something to be done about it, however, and in 1972, that something was done by Congress.

Medicare had passed Congress in 1965 and was still fairly new in 1972. Seeing that cost was one of the main objects, that dialysis was (and remains) expensive, that home dialysis was possible as well as in-center dialysis, and that hundreds of thousands of Americans could be kept alive if they had access to this technology, Congress decided that the one medical condition that would immediately grant someone access to Medicare (and, by extension, payment for dialysis) was ESRD. It took a patient going and dialyzing in front of Congress to get this done, and all of us who have gone on dialysis in this country since that day owe this patient their lives.

I don't know how many lives they saved by doing this, how many more people got to spend more time doing the things they loved with the people they loved. Since 1972? Probably in the millions. Today, some 340,000 Americans are on dialysis and receive Medicare, no matter how old or young they are. Kids are no longer subject to an automatic death sentence. People in middle age need not dread their 45th birthday. One's "social worth" is no longer a reason to grant or deny dialysis. What Congress did was a deeply humanitarian act, and one that is a double-edged sword, as dialysis is more widely available and even more expensive. Dialysis patients constitute the largest single-group users of Medicare funds.

But there you have it: death panels. Congress did not create them, it caused them to cease. It caused the need for them to no longer exist. Because of the Congress' compassion, ESRD patients can continue to live their lives as fully as possible. Because of Congress' compassion, I did not have to come before a death panel. I live, because of them.

Originally posted to Kitsap River on Sun Aug 23, 2009 at 07:05 AM PDT.

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