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Today’s featured service that the John Locke Foundation doesn’t think the NC Medicaid program should provide: Hospice care

As we reported earlier this week in the most recent edition of The Weekly Briefing (Locke-ing out the poor: The right's radical health care plan for people in need), one of the most underreported tactics employed by Raleigh's far right policy think tanks is their penchant for floating policy proposals that find "big savings" in public budgets by casually proposing the elimination of numerous essential public services.

Most recently, one can see this tactic employed in the Locke Foundation's Agenda 2008: A Candidate's Guide to Key Issues in North Carolina Public Policy. There, the group trots out a proposal that they have been flogging for years (to little effect, thankfully) – the idea that North Carolina's health care program for people of low income (Medicaid) should only provide the basic, bare-bones services mandated by the federal government. Such a move would require the elimination all so-called "optional services."

Today we begin a series of blog posts that will examine some of those "optional" services that the Locke group would cut. Our first featured service: Hospice care.

Just what is hospice care and why is it covered? Well, contrary to the common misunderstanding of many, hospice is not just a place that people with cancer or AIDS "go to die." Hospice is, in fact, one of the great innovations of modern health care – a multi-faceted service that regularly provides an enormous boost to the quality of life of people entering their final days, weeks or months of life. Rather than being merely "a place to go" hospice care is, in fact, an array of services that are provided to people nearing the end of life (and their loved ones). Often, in fact, hospice professionals and experts go to the person in need – in their home or in a nursing facility.

As of 2006, North Carolina was one of 47 states (and the District of Columbia) whose Medicaid program's covered hospice care. The cost was roughly $53 million or around 2/3 of 1% of the total Medicaid budget (of which the majority is paid by the feds).

According to a report published in the Journal of Pain and Symptom Management, a recent study found that terminally ill hospice patients with certain diseases live a significantly longer period of time than do their non-hospice counterparts. Indeed, across all patient groups studied, those enrolled in hospice lived an average of 29 days longer than those who did not choose hospice.

Is hospice perfect? Of course not. There is a continuum of providers in the hospice world. Like other areas of health care, the "for profit" providers often bear close watching to assure that they are not just cherry picking the most profitable clients. Some critics have also noted that the provision and availability of hospice care to people of color has lagged behind that of white patients – though this would hardly militate against Medicaid coverage. There are undoubtedly other issues as well.

The bottom line, however, seems to be obvious: hospice care is an essential and important service. It is irresponsible to casually suggest that it should be denied to the poor.

One Comment


  1. James

    September 5, 2008 at 4:00 pm

    Ah, but you miss the point. Poor people are chosen by god to be the sufferers … and end-of-life suffering is exactly what they deserve the most.

    If they didn’t deserve it, god would have made them rich.

    You see now, don’t you?

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