Medicare is 14% of total federal spending in the United States, and nearly 7% of Medicare money is used for dialysis treatments, which are fully covered. In the United States, dialysis typically takes place in clinics, and costs $87,000 per year. In contrast, other countries use home-based dialysis, which is cheaper and preferred by patients. In the United States, the dialysis industry is an oligopoly, with 83% of the market served by two companies, DaVita and Fresenius. Medicare pays treatment providers per treatment, which may disincentivize better outcomes for the patient, such as preparation for kidney transplant. DaVita employees have been recorded by the Last Week Tonight show misleadingly tellng patients that transplant is an equivalent option to dialysis, even though transplant results in a two to three times increased life expectancy.
