The current proposals that are running through the house and senate will have virtually no impact on DVA or FMS. Everybody with ESRD is already covered by either commercial insurance or Medicare and Medicaid. The dialysis companies do little better than breaking even on the governement plans and take all of their profit from the commercial insurers. A public plan that reimburses at Medicare rates would eventually drive every commercial insurer out of business which would eliminate most of FMS and DVA profits. The public plans in the house and seante bills won't have a price advantage so not as dangerous. There is no mechanism for price controls in the plan so your worry is misplaced.

I would be a lot less worried about reform than what happens to the bundled rate, and how the large chains adjust and if they can maintain their break even status on governement insured patients or if they will start to see high unemployment push more people on to government plans.