ABSTRACT
In the end of the twentieth century most of the medical services industries have been dramatically transformed from poky, independent enterprises into monolithic corporate entities wielding billions of dollars in physical assets and political influence. The most unusual health care program under Medicare’s purview is the End Stage Renal Disease (ESRD) Program. Dialysis treatment for ESRD is the only health care expense reimbursed by Medicare that people of all ages are entitled to. Chronic or end-stage renal disease is a condition caused by kidneys no longer capable of purging toxins from the blood. There are two treatment options: renal dialysis or a kidney transplant. Prior to 1973 overt racism and sexism, as well as economic barriers restricted treatment of women and minorities for ESRD. The Clinical Laboratory Improvement Amendments of 1988 (CLIA) included provisions for regulating every medical laboratory in the United States—large and small, public and private, office based and hospital based.
