COBRA put into effect the Medicare hospice benefit permanently after it originated in 1982 with a sunset provision, as the hospice program continued to thrive in patient satisfaction and to yield its savings compared to inpatient hospital treatment (Gage et al., 2000).  The program’s success also led to giving states the option of including hospice as a provision under Medicaid as well.

         While research qualified the goals of hospice, politically the hospice benefit never would have arisen as an issue without the growing awareness of the needs of the dying, sparked by the hospice movement.  Originating twenty years prior to this act by Dr. Cicely Saunders who founded the first hospice called St. Christopher’s, in London, the hospice movement aimed to educate people on the need to provide pain relief and support to the dying person and his or her family when treatment is no longer beneficial (National Hospice Organization, 2000).  People in the United Sates such as Dr. Elizabeth Kubler-Ross, who wrote On Death and Dying, also worked to influence professionals and the terminally ill to establish a place within the health care system where the last stages of life would be reinforced with patient choice and comfort.  The first hospice in the United States was established in 1974, and in 1977 the National Hospice Organization was founded (National Hospice Organization, 2000).

        The growing need for access to hospice programs among those who could not afford it was increasing along with the developing number of these programs.  For family members who were coping with the stress of grief in addition to the financial strain of medical bills, the need for assistance was desperate (Kastenbaum, 1979).

        The significance of choosing to allot federal funds towards hospice lies in the indication that as a country we were changing our attitudes towards the dying and we were willing to expand our perception of our health care system beyond the drive to treat and to cure.  This policy allowed for the awareness that treatment does not always cure, and in those instances, there is a responsibility accept the patient’s state and to provide quality supportive care (Kastenbaum, 1979).  In addition, the family system was recognized and included in the hospice benefit, reflecting the growing awareness of how all those connected to the dying patient benefit from such services. This support gives more control to the patient and the family (Brody, 1982).

         As ultimately declared by research, hospice proved to make a difference economically and humanely.  COBRA permanently gave terminally ill patients the right to choose to discontinue treatment and to die with dignity in a hospice facility or home with familial, emotional, medical, and spiritual support.  The financial support through Medicare was essential in giving all people this sense of dignity.  Due to the efforts of those who pioneered the hospice movement and due to the professionals who made hospice work, the implementation of the hospice benefit was both needed and desirable, and revolutionary in its focus.