HR 1, the bill originating in the House of Representatives which established Medicare eligibility for those with kidney failure, was passed by the House and Senate, signed into law by President Nixon and implemented on July 1, 1973. This legislation was passed after years of effort by many nephrologists, patients, lobbyists, renal organizations, congressmen and congressional staff. Among them were Dr. George Shreiner, who began the dialysis program at Georgetown University; Dr. Ira Greifer, who began the pediatric nephrology program at Albert Einstein School of Medicine in New York; the late Dr. Belding Scribner, who began he dialysis program at Swedish Hospital in Seattle, which later became the Northwest Kidney Center; and Charles Plante, a young government relations lobbyist in Washington, D.C. They worked tirelessly in getting important Congressional leaders educated and enthusiastic about this ground-breaking legislation – for the first time in Medicare history, a specific disease was singled out for Medicare coverage without requiring beneficiaries to be 65 years old for eligibility.

Large bipartisan support for the legislation had been established. However, in the eleventh hour, Shep Glazer, Vice President of the National Association of Patients on Hemodialysis (NAPH) decided the issue was so important he was willing to testify before the House Ways and Means Committee while dialyzing, for the dramatic effect. Two or three days before his scheduled testimony, he called Dr. Schreiner, asking him to arrange for a machine, supplies and hopefully for Dr. Schreiner to monitor the treatment. The two men did not know each other, and Dr. Schreiner was not familiar with Shep’s medical history.

Dr. Schreiner mentioned to me, he and the staff were extremely concerned about a simple problem or two during the proposed treatments, such as a needle coming out, or Shep fainting from hypotension which might endanger the passage of the legislation. They knew they could take care of Shep in an emergency, even though they had never met him. Cardiovascular instability was common among hemodialysis patients. Shep was insistent about testifying while dialyzing and did not provide important details of his medical history. Dr. Schreiner wanted someone who could be calm, cool and able to work under stress. He found just the person to supervise the treatment in one of his nephrology fellows who had been in the Navy. Dr. Schreiner instructed him to “end the treatment” if any small irregularity occurred.

Shep walked into the hearing room along with the Georgetown Nephrology Fellow. I was not present, but you can imagine the emotional effect Shep’s presence must have had on those in the room. Shep spoke convincingly about the drastic need for the legislation to be passed and the thousands of lives which would be saved. During Shep’s testimony, the fellow noticed substantial rises in both Shep’s blood pressure and venous pressure. The fellow had no idea why this was happening, as Shep had not explained either to him nor Dr. Schreiner, the cardiac condition Shep had. The fellow clamped the lines and announced “the treatment was over.” Shep was taken off the machine as he completed his testimony. I never knew Shep, and have no way to verify the accounts I’ve heard from Dr. Shreiner and Dr. Chris Blagg, but have no reason to doubt what I’ve been told.

It is clear many people worked very hard to get the legislation passed, and many people and organizations appropriately take credit for assisting in its eventual passage. We’ll never know whether or not Shep’s testimony was frosting on the cake. He had extraordinary courage and gumption to testify while dialyzing, and much credit goes to the nephrology fellow who supervised and had the good judgment to terminate the treatment.

With hindsight, one can imagine an interesting, but diametrically opposed psychology at work here. It certainly is not out of character for long term patients to have very strong confidence that their treatments will go fine, without interruption. As many hemodialysis patients know, we’ve all had moments when good luck has been on our side (and vice versa). Shep, a seasoned dialysis patient with good intentions and an unlimited commitment to the cause of kidney patients may have seen this as a unique opportunity to make quite a strong, positive impact – not even considering Dr. Schreiner’s concerns: the many possibilities of a number of things going wrong during the treatment, which would not shed a positive light on dialysis and possibly compromise passage of HR 1. We all continue to benefit from the persistence of many in getting HR 1 passed into law.

John Newmann, PhD, was the President of AAKP from 1981 to 1984.