Medicare doesn’t cover stuff really important to old people

Katy Butler describes the end of her Father’s life, and laments that the Medicare program will pay endlessly for high tech treatments with little chance of success, but does not cover high touch, low tech long term care that could keep patients comfortable in their homes.

A paper from last year shows that around half of Medicare beneficiaries with Cancer and their families would be willing to reallocate some of their entitlement away from last ditch chemo and the like, and toward high touch, low tech care designed to improve quality of life for patients and family.

The gaps we highlight show beneficiaries and caregivers allocating finite resources toward now-uncovered benefits that broadly speaking are designed to maximize quality of life:

Highlights of a prior post on this study (JCO-2014-Taylor-3163-8).

  • unrestricted cash  (some level chosen by 46%)
  • home based long term care (52% choose a level far beyond what home health would cover)
  • concurrent palliative care (45% chose a level beyond the current hospice benefit; such care without having to unelect curative treatments)

The numbers highlighted in yellow (from Table 3 in the paper) correspond to the text just above, and show the distribution of subjects choosing benefits not now covered by Medicare at the initial assessment in the study (subjects did multiple assessments; their selection of non covered benefits was relatively stable before and after facilitated discussions).

ScreenHunter_02 Aug. 25 16.17

The key to our study (there are limitations) was that the above results represent patients and families saying they would reallocate finite resources away from the current Medicare benefit package, and toward these other 3 hypothetical benefits; they were not just adding these on top of everything else.

The most important thing not being discussed in the Presidential election is how our society will address the long term care needs of the baby boomers. Patients and families, with better information and more choices in how they consume their Medicare entitlement, could lead to a partial solution, within the planned aggregate spending of the Medicare program.


*Donald H. Taylor, Jr., Marion Danis, S. Yousuf Zafar, Lynn J. Howie, Gregory P. Samsa, Steven P. Wolf, Amy P. Abernethy. There is a Mismatch Between the Medicare Benefit Package and the Preferences of Patients with Cancer and Their Caregivers. Journal of Clinical Oncology 2014; 32(28):3163-68.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to Medicare doesn’t cover stuff really important to old people

  1. Pingback: Rounding out the Moon Shot | freeforall

  2. Pingback: Hospice and its place in the LTC system | freeforall

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