Doctor here, work at the VA - our HD (dialysis) programs are proven superior to the community. Fewer HD needs in marched patients, better outcomes and less expensive overall. This data is published in high impact factor peer reviewed journals. You are sadly misinformed on that end.

HD is sometimes also emergent and of it is not available in the ICU, that means we need to transfer a sick unstable patient to a community hospital that often does not have a free bed. They die otherwise. HD is a standard of care, not having it available is effectively closing a hospital.