ProPublica gets the story and the spin memo

ProPublica reporter Robin Fields, a former L.A. Times investigative reporter, landed a major project this morning on the morass that the federal kidney dialysis program has become:

Now, almost four decades later, a program once envisioned as a model for a national health care system has evolved into a hulking monster. Taxpayers spend more than $20 billion a year to care for those on dialysis -- about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world's highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy's, or France's, or Japan's, thousands fewer patients would die each year.

In a country that regularly boasts about its superior medical system, such results might be cause for outrage. But although dialysis is a lifeline for almost 400,000 Americans, few outside this insular world have probed why a program with such compassionate aims produces such troubling outcomes. Even during a fervid national debate over health care, the state of dialysis garnered little public attention....

At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care...Meanwhile, the two corporate chains that dominate the dialysis-care system are consistently profitable, together making about $2 billion in operating profits a year.

With the story, ProPublica got the extra thrill of running a leaked memo detailing how the advocacy and lobbying organization for dialysis providers, patient groups and drug companies planned to respond to the investigation. Plus a ProPublica editor's note: How we got the government’s secret dialysis data