Post
While once American hospices were run by nonprofits and charities, that changed in 1983 with the introduction of Medicare's hospice benefit. Today, three quarters of US hospices are private.
It's not just PE-backed hospices; the entire for-profit hospice sector is worse than the nonprofit alternative. For-profit hospices deliver worse care and worse outcomes at higher prices. They are the worst-performing hospices in the country.
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This is because (as Rothermich writes) "The actual provision of care—the act of healing or attempting to heal—is broadly understood to be something more than a purely economic transaction." In other words, patients are not customers. In the hierarchy of institutional obligations, "patients" rank *higher* than customers. To be transformed from a "patient" into a "customer" is to be severely demoted.
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Hospice care is a complex, multidisciplinary, highly individualized practice, and pain treatment spans many dimensions: "psychological, social, emotional, and spiritual as well as physical." A cash-for-service model inevitably flattens this into "a standardized list of discrete services that can each be given a monetary value: pain medication, durable medical equipment, skilled nursing visits, access to a chaplain."
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As Rothermich writes, while there are benefits to blocking PE rollups and monopolization of hospices, to do so at all tacitly concedes that health care should be treated as a business, that "corporate involvement in care delivery is an inevitable, irreversible development."
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Rothermich's point is that health care isn't a commodity, and to treat it as such always worsens care. It dooms patients to choosing between different kinds of horrors, and subjects health care worker to the moral injury of failing their duty to their patients in order to serve them as customers.
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I'm on a tour with my new book, the international bestseller *Enshittification*!
Catch me next in #Cardiff (TONIGHT!), #Oxford and #London!
Full schedule with dates and links at:
https://pluralistic.net/tour
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