Washington spends a lot of time talking about how to “fix” health care. But the biggest problem isn’t political; it’s process—a silent crisis that’s costing taxpayers more than any bill Congress will debate this year—undiagnosed, untreated chronic disease.
Three in four US adults live with at least one chronic condition, consuming over $4 trillion in government health care spending. In many cases, these conditions go undetected and untreated until they become severe. The result? A system that is upside down, resulting in enormous spending to treat late-stage symptoms instead of catching disease early, when treatment is cheaper, more effective, and far less devastating to patients.
Few conditions expose this dysfunction as starkly as chronic kidney disease (CKD).
More than 35 million Americans have CKD, yet 9 in 10 don’t know it. That lack of awareness isn’t just a medical failure; it’s a financial one. Nearly one in four Medicare dollars, roughly $95 billion each year, are spent on care for patients with CKD. And that figure excludes the enormous cost of end-stage renal disease (ESRD), when kidneys fail, and treatment options are limited to dialysis or transplant. At that point, lives are already upended, personal productivity diminishes, and costs skyrocket. It’s an unfortunate and dangerous example of our broader national problem. One thing is clear: this path is unsustainable—for patients individually and our nation as a whole.
The progression of CKD, like many chronic conditions, is preventable. And that’s not only good medicine—it’s sound economics.
While the kidney care conversation has historically focused on dialysis, innovations in diagnostics and therapies makes this the right time to focus on pathways to early detection and treatment. We know what works: regular checkups, routine blood work, and early screening for high-risk individuals, paired with healthy lifestyle habits. For people with diabetes or hypertension—two of the most common precursors to CKD—monitoring kidney function should be as routine as checking blood pressure or blood sugar. And when appropriate, access to FDA-approved treatments can further help preserve crucial kidney function. Taken early, these steps can prevent or delay incremental and often invisible kidney damage long before dialysis becomes the only option.
Alas, our system isn’t set up to pay for prevention. This outdated status quo must not stand.
Today, Medicare picks up the tab for diseases that develop decades earlier. And, until recently, employer health plans and other private insurers—who cover individuals during their working years—have not had tools to holistically address kidney health and justify needed investments in long-term kidney disease prevention. Today, as new diagnostic technologies make earlier treatment options available—the reimbursement model hasn’t kept up—financial benefits often materialize only after patients transition to Medicare. The result is predictable: underinvestment in early, cost-effective care followed by catastrophic spending later.
Nowhere is this misalignment more evident than in CKD. Prioritizing early intervention in CKD could save $9 billion for Medicare each year. ESRD is one of only two conditions that entitles someone to Medicare coverage regardless of age. In other words, Medicare becomes the insurer of last resort once a patient reaches the most expensive stage of the disease. By then it’s too late bad for taxpayers—and too late for patients.
We have an opportunity to remedy this situation. Congress should authorize the Centers for Medicare & Medicaid Services (CMS) to launch a shared savings model that rewards private insurers and employers that invest in early detection, prevention, and improved patient outcomes. This innovative model would:
- Encourage earlier testing and intervention for chronic conditions like CKD, diabetes, and heart disease.
- Improve long-term health outcomes and reduce avoidable complications; and,
- Generate measurable savings for Medicare while rewarding organizations that prioritize prevention.
This is a chance to redesign the economics of American health care, to shift our system from reactive treatment to proactive care. If Washington wants to slow spending, strengthen our workforce, reduce disability, and improve the lives of millions of Americans, prevention of CKD is the place to start. It’s a solution that matches advances in treatment options with common sense.
A system that waits to pay the most once patients are the sickest is a system that fails basic healthcare economics and fails patients. It’s time to empower CMS to reward prevention. It’s a smarter, fairer, more fiscally responsible path forward—and it’s better for patients. Let’s do the right thing.
Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest.
