How to Make a Killing: Blood, Death and Dollars in American Medicine

Book excerpt: “Inspiring and deeply distressing.” —Ezekiel J. Emanuel, author of Which Country Has the World’s Best Health Care? How did a lifesaving medical breakthrough become a for-profit enterprise that threatens many of the people it’s meant to save? Six decades ago, visionary doctors achieved the impossible: the humble kidney, acknowledged since ancient times to be as essential to life as the heart, became the first human organ to be successfully replaced with a machine. Yet huge dialysis corporations, ambitious doctor-entrepreneurs and Beltway lobbyists soon turned this medical miracle into an early experiment in for-profit medicine—and one of the nation’s worst healthcare catastrophes. With powerful insight and on-the-ground reporting, New York Times best-selling author Tom Mueller introduces an unforgettable cast of characters. Heroic patients, including a Hollywood stuntman and body double, risk their lives to blow the whistle on how they’ve been mistreated. An unpaid activist living in a south Georgia trailer park fights to save patients from involuntary discharge from their lifesaving care. Industry insiders put their careers on the line to speak out about the endemic wrongs and pervasive inequality they’ve witnessed—and about dialysis executives who dress as musketeers and Star Wars characters to exhort their employees to more aggressive profit-seeking. Mueller evokes the scientific ingenuity and optimism of the 1950s and 1960s, when the burgeoning field of organ transplant and early dialysis machines offered long-awaited hope for lifesaving care. That is, until a New York salesman had himself dialyzed on the floor of the House, and Congress made renal disease the only “Medicare for All” condition—opening the financial floodgates for Big Dialysis. Of the thousands caught in a web of corporate greed, a disproportionate number are Black and Latino, highlighting the stark racial divides already endemic to American medicine. How to Make a Killing reveals dialysis as a microcosm of American medicine and poses a vital challenge: find a way to fix dialysis, and we’ll have a fighting chance of fixing our country’s dysfunctional healthcare system as a whole, restoring patients, not profits, as its true purpose.