Dialysis is a medical miracle, a treatment that allows people with kidney failure to live when otherwise they would die. It also provides a captive customer for the dialysis industry, which values the steady revenues that come from critically required long-term care that is guaranteed by the government.

Tom Mueller's six year deep dive into the dialysis industry has yielded his latest book, How to Make a Killing: Blood, Death, and Dollars in American Medicine (W. W. Norton, 2023). It's both an historical account of this lifesaving treatment and an indictment of the industry that is dominated by two for-profit companies that control ~80% of the market.

There is a precarious balance between ethical care for patients and the prioritization of profits for the providers, a tension that has led to ethical, political, and legal debates about the rationing and exploitation of life-saving care and quality of life.

Dialysis services are desperately needed by patients who require the dangerous, uncomfortable, and exhausting treatments multiple times per week, and pay for it through complex insurance procedures.

Tom Mueller’s book includes a vivid account of CEOs who lead their companies with messianic zeal to drive revenues continually up while simultaneously reducing the cost of care. He introduces us to the doctors charged with reducing those costs even at the expense of high-quality care and negative health outcomes. And we meet the patients themselves, who have little choice but to put their lives and well-being at the mercy of this system.

How did a lifesaving medical breakthrough become a for-profit enterprise that threatens many of the people it’s meant to save? And who are the brave people -patients, doctors, and employees of the system who are willing to tell their stories despite tremendous pressure to remain silent? And why do we as Americans accept worse outcomes at higher costs than the rest of the world?

Tom Mueller's highly readable yet devastating book illustrates the dialysis industry as a microcosm of American medicine.

Mueller challenges us to find a solution for dialysis, an approach that could also provide the opportunity to begin fixing our country’s dysfunctional healthcare system and a fighting chance at restoring human health outcomes, rather than the extraction of profits, as its true purpose.

To contact Tom Mueller, visit www.tommueller.co

Suggested reading:

The Body's Keepers by Paul L. Kimmel, M.D.
The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No by Carl Elliott

Also mentioned:

How to Get Away with Merger by Thomas G. Wollman (NBER working paper, 2020)
"How Acquisitions Affect Firm Behavior and Performance" by Eliason, Heebsh et al. (The Quarterly Journal of Economics, 2020)

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