Column 2It's About How you Live
Lynn Bonde, Executive Director
Most of the people we meet in hospice have Medicare. That makes sense because the end of life usually, but certainly not always, happens after many years have been lived. What most people don’t know, whether they are currently enrolled in Medicare or are looking at Medicare from some distance, is that Medicare includes a special benefit that covers hospice care.
Medicare is only a little more than 45 years old. It came into being as part of President Lyndon Johnson’s Great Society legislation in July, 1965. But government health care coverage was part of the debate on social insurance all the way back to President Roosevelt and the creation of Social Security in 1935. It was not adopted with the other parts of the New Deal, but the idea continued to be worked on by analysts and politicians. After the end of World War II, President Truman championed a program of universal government health insurance, known then as National Health Insurance. It was a plan that would cover everyone, but, for many reasons, did not garner sufficient political support to be enacted.
The notion of a more limited government health insurance program to benefit those on Social Security was developed during the Eisenhower Administration. Expansion of government health coverage to military dependents and a growing interest in the needs of the elderly during the 1950s presaged the introduction of legislation to expand Social Security to include health care insurance. But the bill proposing this broad, new program was not introduced until 1960, an election year. Despite support for health insurance for all Social Security beneficiaries, there was enough opposition to produce a more limited program that covered only the poorest seniors through their State welfare offices.
Although President Kennedy supported expanding health coverage to all senior citizens, his Administration was unable to muster the votes in Congress necessary to enact it. After his assassination, President Johnson adopted Medicare, as it had come to be known, as one of his top legislative priorities. Finally, the President was able to muster the required votes to pass the Medicare bill in July, 1965.
Given this history, it was a relatively short 17 years later that Congress adopted the Medicare Hospice Benefit in 1982. And it has changed little in the last 25 years. The benefit covers all the staff hospice brings into a family’s home: nurse, social worker, home health aide, chaplain, and volunteers. It also covers all the costs of equipment and supplies necessary for the patient to remain at home, including a hospital bed, wheelchair, wound care supplies, and so on. The benefit covers all medications and therapies the patient may need to help manage pain or other symptoms related to the condition or disease that has brought him or her to hospice. The hospice bills Medicare a fixed rate for every day the patient is enrolled in hospice, and pays for all of the staff, equipment, and medications out of the amounts Medicare sends us.
Even with the double digit increases in the cost of medications over the years, the Medicare Hospice Benefit has grown only between 1% and 3% each year. And today, in this climate of budgetary constraints and concerns about the growth of Medicare generally, the Administration’s budget proposal for the coming fiscal year unfortunately includes a 15% reduction in the hospice reimbursement rate. We are working with our representatives in Congress to prevent this result, but even if this reduction takes place, we will continue to provide the highest quality of hospice care in Calvert County, no matter what.
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