Pope Francis passed away this morning at the age of 88. Just weeks ago, he had spent 38 days hospitalized at Rome’s Gemelli Hospital for what was described as “double pneumonia,” before returning to his Vatican apartment to recover.

Had he been an American hospitalized in the U.S., he might not have made it even that far.

As both a geriatric doctor and a patient, I have seen firsthand how the U.S. health care system increasingly pushes hospitalized patients toward hospice—not for medical benefit, but to protect profits.

After decades of increase, life expectancy in the U.S. is now on the decline. Harvard and Johns Hopkins researchers point to the pandemic and fentanyl overdoses as causes. I would argue there’s another overlooked factor: premature hospice referrals.

If you’re hospitalized—especially under Medicare—and debilitated by illness, you’ll likely be asked about hospice care by day five. This push is often framed as a discussion about “palliative care,” softening the real financial motivations behind it.

Why day five? Medicare reimburses hospitals with a lump sum for each diagnosis, known as a DRG (Diagnosis-Related Group). For a diagnosis like “bilateral pneumonia” (the medical term for what the Pope had), the fixed payment is about $5,000—regardless of whether your stay is two days or 38.

If you’re discharged early, the hospital makes money. If you stay too long, they lose money. And if they discharge you too early and you return, they face penalties. So, the “solution”? Move you to hospice. That way, the hospital is off the hook financially, and your care costs shift elsewhere.

This system invites disturbing comparisons. Imagine a plumber being offered a flat $5,000 to fix unknown leaks and clogs without knowing what the job involves. Few would take that deal. Yet hospitals are doing this daily—with human lives on the line.

Patients with serious illnesses often have hidden complications. A diagnosis of pneumonia may mask aspiration due to swallowing issues, lung cancer, or toxic exposure. Discharging these patients early without a full workup almost guarantees a return visit—or worse.

Years ago, hospitals were paid by the day, which led to unnecessary long stays. The DRG system was introduced to curb that abuse—but it overcorrected, replacing one flaw with another. Today’s system incentivizes early discharge and hospice enrollment, not full recovery.

Hospice should be a choice, not a business strategy. I have seen providers appeal to families by emphasizing suffering. But all patients suffer. That does not mean they cannot recover—especially with proper care. Pope Francis’s 38-day hospitalization proves that survivable outcomes are possible, even for the very ill and very old.

How many older Americans were transferred to nursing homes on hospice and died, not from their initial condition, but from the lack of continued care? How many families were pressured into choosing hospice against their better judgment?

Hospice care plays an essential role when used appropriately. But when a hospital uses it to protect their bottom line or help administrators earn bonuses, it becomes a betrayal of medical ethics.

If you or a loved one is hospitalized, be vigilant. Expect the hospice conversation by day five. Ask questions. Seek second opinions. Write down names. Report aggressive behavior. If pressured, remind them: You have the right to full medical care.

Sadly, most Americans won’t receive the kind of sustained hospital care Pope Francis did. And without major reform, our life expectancy—and dignity in aging—will continue to suffer.

Unless, of course, you’re the Pope.

Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report.