Aligning Hospice Payment and Benefit Design with Patient Need Executive Summary This proposal advances three integrated reforms: (1) replace the six-month prognostic eligibility requirement with diagnosis of terminal illness; (2) integrate hospice fully into the Medicare benefit; and (3) transition reimbursement to a guardrailed, reasonable cost-based model. These reforms are supported by extensive evidence that hospice reduces Medicare spending while improving care, but also recognizes that...

This past week, I had the privilege of speaking to pre-med students, graduate students, and faculty in the medical sciences at the University of Notre Dame. My topic was “How We Die in America: Fear, Faith, and the Moral Limits of Medicine." Over the last several generations, dying in America has changed dramatically. What was once primarily a spiritual and family-centered event has evolved into a medical technology event. This lecture focused on dying in America and healthcare's role in...

America’s healthcare crisis is not caused by one bad policy or one failing program. The system is breaking because it is built on incentives that undermine affordability, coordination, and quality. When you look across the major failures — rising costs, fragmented care, clinician burnout, unnecessary utilization, fraud, and overwhelming administrative burden — a single pattern emerges: these are symptoms of a fundamental design flaw. Affordability Is the Breaking Point ACA premiums keep...