If everyone had an advance directive, end of life care costs might decline, families and providers wouldn’t have to guess about patient wishes and liability issues, and each of us might start to think more about our own responsibility for our health and our own expectations.
That seems to me pretty straightforward, a win for the individual, the insurer, the system.
So I suggested that a part of having health insurance should be requiring an advance directive. There are easy universal forms available. Each person can choose from wanting everything to wanting only to be made comfortable. If they can discuss with family, friends, clergy, medical people. No big deal.
Somehow this has gotten monetized, been folding into discussions on rationing, and there is now a proposal that Medicare reimburse for advance directive counseling. Medicare serves seniors and people with disabilities; this group has become inflamed. That counsel fee is being perceived as depriving seniors their rights to be helped with costly interventions.
Sure we are talking about unsustainable Medicare costs, but we are also talking about sharing costs and social involvement.
We’d have a similar impact if everyone who had insurance was required by the insurer (public and private) to have an advance directive. That directive could just fold over into their coverage when they became Medicare-eligible. Maybe not as fast, but simple.
I don’t know who introduced the idea of associating directives with Medicare. Maybe someone was not thinking beyond a short-term budget savings, not thinking of the personal reaction. Maybe someone was deliberately trying to upset seniors with the hope of scuttling all healthcare change. It’s hard for me to understand how this good idea actually got included in the package in sure-to-fail way.