A Satirical Dispatch From the Department of Please Die More Efficiently

Robert F. Kennedy Jr. did not announce a federal program requiring hospice patients to die on schedule. He did, however, manage to discuss suspicious hospice cases using language about patients who “would just never die,” which is such an astonishing phrase for the secretary of Health and Human Services that satire barely has to clock in.

There are public officials who misspeak.

There are public officials who put their foot in their mouth.

Then there is RFK Jr., who occasionally appears to swallow the entire shoe rack, look directly into the camera, and ask whether anyone has considered the health benefits of leather.

His recent discussion of hospice fraud gave America another one of those moments.

The concern, in context, involved people improperly enrolled in hospice and Medicare being billed for patients who were not actually near the end of life. Fair subject. Serious issue. Worth investigating.

Then came the observation that some hospice patients “would just never die.”

I am sorry.

Once the secretary of Health and Human Services complains that hospice patients have developed an inconvenient habit of remaining alive, the satire practically writes itself.

Apparently, America has discovered the newest threat to fiscal responsibility:

Gertrude is still breathing.

Welcome to Hospice: Please Observe the Suggested Checkout Time

Perhaps we have misunderstood hospice all these years.

I thought hospice was about comfort, dignity, pain control, family support and helping people live whatever time remains with as much peace as medicine can provide.

Silly me.

Apparently, it is a hotel with an aggressively enforced checkout policy.

“Good morning, Mrs. Henderson. How are you feeling?”

“Pretty good today.”

“Oh.”

“Is something wrong?”

“No, no. We are thrilled. Absolutely delighted.”

“You do not sound delighted.”

“Well, Medicare had you penciled in for Tuesday.”

It is Thursday.

Mrs. Henderson is sitting upright, drinking coffee and watching The Price Is Right.

Someone in Washington is sweating.

The actuarial tables said one thing.

Mrs. Henderson said, “Bob Barker would never tolerate this nonsense,” and requested another piece of toast.

We now have a crisis.

The Department of Timely Departures

I expect HHS to correct this shocking lack of mortality discipline with a new agency.

The Department of Timely Departures will monitor hospice patients who show suspicious signs of continued existence.

Red flags may include:

• requesting seconds at dinner;
• asking what is on television tomorrow;
• making plans for Christmas;
• ordering anything with two-day shipping;
• renewing a library book;
• planting tomatoes;
• saying, “See you next week” without displaying appropriate bureaucratic remorse.

Repeat offenders may receive a letter.

Dear Medicare Beneficiary:

Our records indicate that you remain alive.

This is your third notice.

Your physician previously estimated that your illness may limit your life expectancy. You have responded by continuing to exist.

Please explain.

Failure to respond within 30 days may result in further existence.

Sincerely,

United States Department of Health and Human Services

Imagine the hearings.

“Secretary Kennedy, how did you identify the fraudulent hospice cases?”

“Well, Senator, some of these people kept living.”

“For how long?”

“Years.”

“And that raised concerns?”

“Obviously.”

“Could they simply have been stubborn?”

“We have not ruled it out.”

Iowa would immediately become a federal target.

You tell an 87-year-old Iowa grandmother that Washington expects her to die by March and she may survive until 104 out of spite.

Medicare Introduces a Loyalty Program

We need incentives.

Stay in hospice 90 days and earn Bronze Status.

Six months gets you Silver.

One year earns Gold, priority boarding and a complimentary visit from a federal auditor asking, “What exactly are you trying to pull here?”

Two years gets you Platinum.

At Platinum level, the government stops pretending it knows when you are going to die and simply sends someone every few months to glare suspiciously through the living-room window.

“Is Edna still alive?”

“Yes.”

“Dammit.”

At three years, Edna gets a free tote bag reading:

I OUTLIVED MY PROGNOSIS AND ALL I GOT WAS THIS MEDICARE INVESTIGATION

Frankly, I would buy one.

Hospice Is Going to Need a Productivity Dashboard

Corporate America has taught us that every human activity can be improved by turning it into a spreadsheet.

Why should dying be exempt?

Hospice administrators could receive quarterly metrics.

Q3 END-OF-LIFE PERFORMANCE REPORT

Projected deaths: 47
Actual deaths: 39
Variance: 8
Explanation: Patients uncooperative

Regional managers will hold emergency Zoom meetings.

“Des Moines, your numbers are concerning.”

“We know.”

“What happened?”

“Three patients stabilized.”

“Have you addressed that?”

“We gave them medication.”

“And?”

“They felt better.”

Silence.

Someone from accounting turns off their camera.

“Do you understand what you have done?”

“We provided good medical care.”

“Jesus Christ.”

That is how absurd this becomes the instant we start treating human survival as a performance problem.

Hospice care cannot be reduced to an expiration-date management system. Human bodies have never shown much respect for bureaucracy, hospital scheduling, insurance projections or anyone’s Outlook calendar.

Death arrives when death arrives.

It is famously poor at RSVP etiquette.

The Hospice Drive-Thru

Perhaps the government could modernize hospice.

Pull up.

Scan your Medicare card.

Choose your package.

OPTION A: Comfort Care Classic

Pain control, nursing support, family counseling and absolutely no pressure.

OPTION B: Medicare Saver

Same care, but a federal employee sighs loudly whenever you wake up.

OPTION C: Fiscal Responsibility Deluxe

Includes morphine, chaplain services, one warm blanket and a countdown clock visible from space.

At the second window, someone asks:

“Would you like fries with that?”

“No.”

“Excellent. That moves things along.”

Too dark?

Yes.

That is the point.

Satire works best when the joke gets uncomfortably close to something we would rather not think about.

America is very good at talking about health-care spending.

We are less comfortable talking about what the spending represents.

A “high-cost beneficiary” may be somebody’s mother.

A “long hospice stay” may be six extra months a grandfather got with his family.

A “utilization issue” may be a nurse preventing someone from spending their final days in agony.

Language sanitizes things.

Spreadsheets sanitize them further.

Then somebody says patients “would just never die,” and suddenly the euphemism falls off the table.

Hospice Is Not Where We Send People to Hurry Up

Hospice has one of the worst public-relations problems in American medicine.

People hear “hospice” and think death squad.

They think the doctors have surrendered.

They think medicine has stopped.

They think someone takes away all treatment, dims the lights and waits.

Hospice is care.

Different care.

The central question changes from “How do we cure this disease?” to “How do we make this person comfortable, supported and heard during whatever time remains?”

That distinction matters enormously.

A hospice nurse may spend an afternoon controlling severe pain.

A social worker may help a family figure out what happens when the primary caregiver is completely exhausted.

A chaplain may sit with someone who is terrified.

An aide may help a person bathe without making them feel humiliated.

A nurse may explain to a frightened daughter that the changes she is seeing are part of the dying process.

Sometimes the greatest service hospice provides is simply having someone knowledgeable in the room when everyone else is scared out of their minds.

There is no stopwatch.

There should never be a stopwatch.

Still Alive? Please Press One

I can already hear the automated federal hotline.

“Thank you for calling Medicare Hospice Compliance.”

“If you are currently dead, press one.”

“If you expect to die within six months, press two.”

“If you have exceeded your projected life expectancy, press three.”

“If you are unsure whether you are alive, remain on the line.”

“If you are Robert F. Kennedy Jr., please stop giving satire writers material faster than they can process it.”

That final option may require additional staffing.

Fraud Is Real. So Is Dignity.

There is a perfectly serious issue underneath all this absurdity.

Hospice fraud is vile.

Anyone enrolling healthy people in hospice, falsifying records, exploiting Medicare or using dying patients as billing opportunities deserves investigation and prosecution.

No argument from me.

Investigate it.

Audit it.

Prosecute it.

Shut fraudulent providers down.

Take the money back.

Then maybe, just maybe, talk about the people involved without making it sound like their failure to die has become a federal inconvenience.

The secretary of Health and Human Services occupies a position where language carries weight.

People listen.

Patients listen.

Families listen.

Older Americans listen.

Disabled people listen.

People with terminal illnesses listen.

Some of them already worry that they are burdens.

They worry about what their care costs.

They worry about exhausting their families.

They worry about needing help to eat, bathe, dress or use the bathroom.

They worry that everybody would be better off once they are gone.

That is exactly the population that does not need to hear anyone in government sounding impatient with the timetable.

Please Stop Failing Your Prognosis

Medicine predicts.

Bodies improvise.

Doctors may estimate six months and get three weeks.

They may estimate weeks and get months.

Someone may decline dramatically, stabilize, decline again, rally for Thanksgiving dinner, spend three days telling stories, sleep through most of December and wake up one morning demanding scrambled eggs.

Human beings are terribly inconsiderate that way.

We refuse to die according to PowerPoint.

Perhaps that is the real lesson here.

Hospice is not about scheduling death.

It is about caring for life when life has become fragile.

That difference is enormous.

A society reveals quite a bit about itself in how it treats people who can no longer produce, earn, work, compete or contribute in the ways capitalism prefers.

The person in a hospice bed may no longer have measurable economic output.

They remain a person.

That should not be a controversial sentence.

Somehow, in America, give us another election cycle and a congressional budget committee, and we will see what happens.

Dear Hospice Patients: Be Difficult

So here is my completely unauthorized advice to every hospice patient currently offending a spreadsheet.

Be inconvenient.

Wake up tomorrow.

Ask for pancakes.

Complain about the coffee.

Demand the good blanket.

Tell your grandchildren embarrassing stories about their parents.

Watch another baseball game.

Order dessert.

Change your mind three times.

Ask the nurse questions.

Make someone move the television two inches to the left, decide it was better before, then ask them to move it back.

Stay exactly as long as your body decides to stay.

Three hours.

Three days.

Three months.

Three years.

You do not owe Medicare punctuality.

You do not owe Washington an efficient death.

You do not owe an insurance company the courtesy of disappearing before the next billing cycle.

And if some federal spreadsheet begins flashing red since you had the audacity to wake up again?

Send it a message.

Sorry for the delay.

Still dying.

Will advise.