[ExI] Fwd: What if Medicare required a living will?

Keith Henson hkeithhenson at gmail.com
Thu Apr 28 01:04:27 UTC 2011

This is something I find exceptionally sensible.  Of course, I have
had one for 26 years since it's part o what you must do to be signed
up for cryonic suspension.


Posted at 05:41 PM ET, 04/26/2011

What if Medicare required a living will?

By Ezra Klein

Andrew Sullivan has a proposal to lower health-care costs that
actually makes some sense. “If everyone aged 40 or over simply made
sure we appointed someone to be our power-of-attorney and instructed
that person not to prolong our lives by extraordinary measures if we
lost consciousness in a long, fatal illness or simply old age,” he
writes, “then we’d immediately make a dent in some way on future
healthcare costs. A remarkable proportion of healthcare costs go to
the very last days or hours of our lives.”

His idea is voluntary. But I’d make a different suggestion. What if,
to be eligible for Medicare, you had to give someone power of attorney
and sign a living will? You could tell your attorney, and write in
your will, that you want every possible measure employed to keep you
alive. You could say cost is no object, and neither is pain or quality
of life. You could make whatever choice, and offer whatever
instructions, you want. You just have to do it. You have to make the

Right now, of course, heroic measures are the default. The simple act
of making that choice would cut costs, as I suspect many, many people
would prefer something besides maximal treatment, and would ensure
fewer people suffered needlessly because their health deteriorated
before they made their wishes clear. And although Sarah Palin managed
to rechristen medical counseling about end-of-life options “death
panels,” I choose to believe that that sort of childishness isn’t
inevitable and that this country can make adult decisions about adult

This also raises the question of what other simple choices, or
policies, have the potential to change a major driver of health-care
costs without requiring major reforms to the health-care system. The
floor is open for ideas.

Related: Atul Gawande on end-of-life options.

© 2009 The Washington Post Company

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