Bush Cuts Hospice Funding

Update: A later followup (August 31, 2006) on this piece is available.

President Bush's FY2007 budget proposal would cut Medicare funding for hospice by 0.4% in 2007-2009 according to a message from J. Donald Schumacher, the President of the National Hospice and Palliative Care Organization (NHPCO).  If you think this is a good idea, I encourage you to write a letter of praise to the President.  If you think it is a bad idea, I encourage you to contact your representatives in Congress to educate them on how this could affect the quality of care for people in your community. 

This proposed cut in hospice funding is just a drop in the bucket of the total requested $36 billion of Medicare cuts in various categories for FY2007.  These proposed cuts for FY2007 come on the heels of almost $39 billion in Medicare cuts agreed on for FY 2006.

These proposed cuts are symptoms of a more serious imbalance.  Health care costs are out of control, can we just agree on that?  Most people who have looked at the impact of the aging population on Medicare costs have some concerns that we can't afford all of the care that people are expecting from the system.  So something has to change, either in consumer expectations or in the basic funding model for health care delivery.  But that is a hard, complicated problem.  For that reason, the proposed FY2007 cuts in hospice funding are not necessarily evidence that the policy makers behind them are inherently evil people, as some would suggest.  The Beltway fondness for demonizing and polarizing is the wrong way to discuss this issue.

For a balanced introduction to the economics of end of life care, you can't go wrong reading Joanne Lynn's most recent book, Sick to Death.  You might even want to drop a copy off at the office of your Member of Congress after you drop by to chat with the health staffer.  Joanne pulls no punches (she never does!) as she lays out a "follow the money" analysis of end of life care.  Just one table, "How the money moves" (p. 106) summarizes how current Medicare payment models affect provider net income in ways that you might not expect.

Simply complaining about the proposed cuts will be ineffective because doing so reflects a "me first" mentality that does not address the underlying problem of escalating social costs.  The simplistic "guns versus butter" arguments miss the point that the demographics of the aging population will pose a huge health care burden regardless of what other societal needs may exist, including national defense.  We must find ways to have real dialog instead of just trying to out-shout others, like one of those annoying TV "news" programs where the entertainment comes from watching a pit-bull fight between two extremists.