ONE OF THE few new benefits voted by this Congress will provide people an alternative way to deal with the anguish of terminal illness. Starting at the end of next year, Medicare will offer limited coverage for hospice care, an approach designed to keep dying people free of pain and in their own homes as long as possible.
The hospice movement is relatively new in this country, and most people may not find it a psychologically acceptable alternative to the continuation of active attempts to cure a patient, no matter how hopeless his condition. For an increasing number, however, hospice care is being accepted as a sensible and humane alternative to the often depersonalized and uncomfortable setting of the modern high-technology hospital.
The major reason why Congress agreed to extend this benefit when so many others are being curtailed is that hospice care can be much less expensive than maintaining terminally ill patients in hospitals or nursing homes. Under the new law, hospice patients must be beyond further help of curative treatments and must be cared for primarily in their homes by family members, with the assistance of visiting professionals and volunteers. Other restrictions limit the length and cost of care covered by Medicare and require patients to share in the cost.
It may seem strange to treat in-home care so stringently when comparatively few limits are placed on Medicare coverage of far more expensive forms of care. But the strength of the hospice movement comes in no small part from the dedication and commitment of people who have sponsored it in this and other countries. Extensive use of volunteers has kept costs generally low and made the program more effective in helping both the patient and his family. Unrestricted coverage could translate into a high-cost commercialized service and destroy many of the program's essential elements.
The progress of the hospice movement will be closely watched under the terms of the new law. That's sensible. But there is no excuse for continuing to restrict either public or private medical coverage to the most expensive, highly institutionalized forms of care simply because they are easier to identify and monitor. Over $50 billion a year is now being spent through Medicare. That's worth spending a little effort to administer.