Profit, non-profit, no real difference apparently. When I pointed out once that almost all of the top U.S. private medical insurance companies were non-profit, someone immediately told me that they were just as nasty and greedy as anyone else in the private sector.

An example of natural selection: Some state (I think it was Florida) decided it didn’t need the High Speed Rail money. Did we save some bucks (for a change)? Hell, no. Other states lined up to grab it before it hit the ground. Florida gets nothing for its virtue, and the strongest pigs get the corn.

Government funding is the ultimate Tragedy of the Commons.

The only ones regarding it that way are your capitalist entrepreneurs, folks out for a quick buck, squeezing those dollars out of patient care.

Medicare requires that if one has a hospice program 80% of it must be home hospice. Residential hospice gets only those with medical issues which cannot be handled at home. About half of our patients get better, not well but better, and go home.

And at least 7% must be volunteers, or unpaid staff.

Hospice is used very often instead of hospital care. That’s where the growth is originating. The average cost of a hospital bed is around $3000 per day. The cost of our hospice bed is very close to $300 a day. So this “money sugar fountain” is at the expense of vastly more expensive other forms of care.

Now, like space exploration, private companies are jumping onto this “money sugar fountain” for profit. The hospice for whom I volunteer has been there for 25 years, and I don’t think anyone associated with it regards it as a “money sugar fountain”. And the newer entrepreneurs, capitalists all, the folks jumping into the for-profit market, I suspect they do. The for-profit folks have subverted referral sources, the physicians who refer patients and the people who monitor compliance. They have created marketing departments with budgets for “gifts” to physicians and nursing home managers. Classic, usual capitalism, coming out of the funds needed by patients.

Nope, in this case, it’s not a government cash cow, if the patient is kept in mind. I suppose it can be for the ruthless.

Medicare reimbursement for hospice care has grown from $68.3 million in 1986 to $8.3 billion in 2005 and is expected to hit $45.6 billion by 2030.

It’s the same thing that happened with the mortgage industry: The utopians create a government money sugar fountain, and then wonder why so many flies show up.

Come to that, entire industries exist across the board whose sole function seems to be absorbing government funding of one sort or another. And I speak as someone with experience in the space industry.

And this is what some people denigrate as “free market capitalism.”

It cannot be legislated away, or driven off by sermons and shame, but neither should we assuage our consciences and justify its rapacity (or our participation in it) by elevating it into a noble quest, a holy sacrament. Every person is entitled to increase his prosperity and his security. But no one is entitled to do so at the expense of others.

I salute your volunteer time at the hospice.