Former Health and Human Services Secretary Kathleen Sebelius said Wednesday that one way Congress could improve Medicare is by allowing it to cover more social services for patients with serious or terminal illnesses and their families.
Speaking at an Aspen Institute event titled “Improving Care at the End of Life” in Washington, D.C., Sebelius outlined several ideas that she and others in a strategy group identified to improve care for people with serious illnesses or those entering the end of their lives. She noted that Medicare, the program that covers people with disabilities and adults 65 and older, provides limited hospice assistance but does not provide respite for caregivers or coverage for assistance that help people live at home.
“What Medicare is missing is a whole set of social benefits that could wrap around care delivered at home,” she said, citing activities that assist with daily living at home. “The only way that gets done is through Congress. Congress has to add a benefit, so that is one of these ideas that has to move through Congress.”
Just as Medicare once was expanded to include prescription drugs, if Medicare had been created today, it would have included these social services, she said.
“You would never write a Medicare bill today without a benefit to people growing more dependent but do not want or need hospital-based care,” she said.
Speaking at the event with Sebelius, Victor Dzau, president of the National Academy of Medicine, noted that a focus on social benefits would reduce medical costs and allow for better coordination of groups that assist in end-of-life care. He noted that social services were funded at higher levels in other countries, while medical costs are funded at lower levels.
“I think we’ve got our priorities backwards sometimes,” he said. “We should instead focus on community systems and keeping people well.”
Sebelius was asked to reminisce about her time as health secretary, during which political attacks were waged against a portion of Obamacare that opponents dubbed “death panels.” The provision allows doctors to bill Medicare when they have end-of-life conversations with patients, including about long-term care, advanced directives and other planning tools.
“We felt it was appropriate for doctors to spend time with their patients talking about that and pay that for their time,” Sebelius said.
The Centers for Medicare and Medicaid Services issued a final rule in 2015 allowing for that, six years after it was proposed. Sebelius said that from that experience she learned that the conversation about end-of-life decisions shouldn’t start with government.
“It has to be inspired by communities and faith leaders and patients demanding that the system change,” she said.
