There is a quiet crisis unfolding in American healthcare—one measured not in headlines, but in dialysis chairs, waiting lists, and shortened lives. It is a crisis that disproportionately burdens Black Americans, and it raises a troubling question: who benefits when kidney disease becomes big business?

Black Americans are up to four times more likely to suffer kidney failure than other groups. Despite making up just 13% of the U.S. population, black Americans account for more than 35% of dialysis patients. Both biological and sociological factors are in play here. Genetic differences like APOL1 variants increase medical risk while structural inequalities, including access to care, prevention, and early treatment, are contributing factors for kidney problems.

Now, layer on top of that situation a dialysis industry that has become one of the most concentrated sectors in American healthcare.

Two companies, DaVita and Fresenius Medical Care, control nearly 80% of dialysis facilities nationwide. According to a recent academic study published in JAMA Health Forum, dialysis is now the most consolidated healthcare market in the United States. That should alarm anyone who believes competition drives better........

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