Physicians, patients and the National Kidney Foundation (NKF), worked together on the Congress until October 1972, when the legislation was signed and the Medicare ESRD Program was established.
In addition to the Gottschalk Committee, another committee that was prominent during this era was the Admissions and Policy Committee of the SAKC. It consisted of six random people from different aspects of life that chose who could receive dialysis and who was basically left to die. The committee was composed of a lawyer, housewife, minister, banker, state government official, surgeon and labor leader. Some of the criteria that the committee decided on who would receive treatment was marital status, net worth, occupation, education and church attendance. The question to answer was who would contribute most to society. After patients were chosen they were screened by a physician.
A committee of physicians screened potential patients by strict medical criteria. Medically suitable candidates were then further reviewed by an anonymous lay committee which decided who would get treatment. This difficult decision was based on medical and financial criteria, the perceived ability to adjust to dialysis, family status and the patient’s potential contribution to or burden on society. This committee was active until 1971.
"They intended it to be average citizens and they evaluated the person on things like what kind of contribution they would make in society," said Linda Sellers, public relations manager at NKC. "That was the birth of bioethics, the study and the field of bioethics. Once people started talking about that allocation it became a philosophical discipline to study."
Those were the political highlights of that era. One of the most important highlights that came out around that time was the possibility of home therapies.
Home hemodialysis (HHD) was developed in Boston, Seattle and London on 1964, primarily to save costs at a time when dialysis treatment was not funded by private insurance or other resources. Once HHD was shown to be effective and safe at the University of Washington Hospital program the SAKC started a HHD program in 1966. By 1973, HHD, usually three times a week and often overnight, was being used by almost 40 percent of the 10,000 or so dialysis patients in the United States and by 90 percent of the SAKC patients.
When the Medicare ESRD Program began, it was entitlement program meaning that almost everyone in the United States who developed kidney failure was entitled to treatment. As a result, the dialysis patient population started to increase rapidly and to change as it began to include many older patients and more patients with kidney failure due to diabetes.