Abstract
During the 20th century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the American hospice movement. Idealistic nurses, social workers, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary healthcare reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the healthcare system, it came to be redefined by the politics of health policy and the healthcare industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the healthcare that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain.