“He didn’t always do what he was supposed to do,” she said.

The bad news came with a silver lining: Because he needed dialysis to survive, he was now eligible for Medicare, the government insurance program normally reserved for people 65 and older. The coverage would begin on Jan. 1 and would pay 80 percent of his medical costs; he would be responsible for the other 20 percent, plus a monthly premium of about $100.

For the kind of dialysis he needs, the per-person cost to Medicare was almost $88,000 in 2011, according to the National Institutes of Health. The cost to Mr. Elson, too, would almost certainly be considerable, but he was not thinking about it yet.

He has settled into a new routine, waking at 4:30 a.m. to get to the dialysis clinic by 5 and finish his treatment in time to put in a day’s work. Usually he sleeps through the treatments, curled under a stained blanket he brings from home, a roomful of other dialysis patients filling identical chairs.

“I don’t think there’s a person in here that really wants to do it,” he said as he arrived at the dialysis clinic one morning. “But if the alternative is being six feet under, or doing it, I’m doing it.”

He has lost 70 pounds of water weight and appears re-energized. He has become more careful about what he eats, he said, and his blood sugars have dropped. He can sleep soundly again, with no pain waking him overnight.

Hooked up to the machine one recent morning, Mr. Elson pulled his new Medicare card out of his shirt pocket and held it to the light before carefully tucking it back inside.

“I finally got insurance,” he said. “What a way to get it.”

Then he drifted into sleep.