A Modest Proposal On Healthcare Costs, Ctd

A reader writes:

Why not just require people applying for public or private insurance to complete an advance medical directive and power of attorney as part of the application process? You'd be perfectly free to state the terms and conditions you want, but you'd be required to state your intentions (rather than punt the decision to someone else). Besides the obvious cost of life support in the final days, there's also the issue of liability. Absent instruction, medical personnel will opt for the kitchen sink to avoid being accused of negligence down the line. In any case, I think you're right. It should generate immediate and lasting savings.

Another writes:

Your modest proposal is a wonderful idea, but did you know it's already been tried? 

HR 3200  (the House bill that preceded the Affordable Care Act) contained a provision that would have made it easier for patients to create living wills and limit end of life care voluntarily .  It was very similar to your modest proposal.  See Sec. 1233. Advance Care Planning Consultation here. Of course, this is the provision that came under  heavy fire from Republicans who described it as "government death panels"…

Yes, and I acknowledged this in the post. It is just one of many Republican inconsistencies that they want drastic cuts in collective healthcare spending but cannot countenance anything but maximalist individual healthcare spending. At some point, all those individuals become a collective, especially since we're bound together in insurance pools. Another:

I very much like your idea, though I find fallacy in your presumption about how Christians should approach the subject.  To be certain, it only makes sense that they'd want to be in the arms of their maker sooner (at least it makes sense to me), yet to my knowledge, especially amongst the most devote and evangelical Christians, I fear they'd amount this sort of pre-death decision equivalent to suicide, which in their eyes is seen as disrespectful.  So I doubt they'd ever buy this idea.

They have that right. But it can be framed so this simply allows another to exercise power of attorney on your behalf. You can appoint someone who actually insists on keeping you in animated suspension for years. Or someone who sees nothing wrong with letting go when the time comes, and something almost blasphemous about clinging to life when it has stopped clinging to you. Another:

"Christians, of all people, it seems to me, have nothing to fear from death, and a great deal to gain from giving a few of their own unconscious final days…" And yet, surveys show that it is Evangelical Christians who most want (and demand?) heroic measures to save their loved ones.


After the Terri Schiavo debacle, my wife and I immediately sought out a lawyer to implement a plan similar to your proposal.


I have another modest proposal that is so simple and logical I can’t figure out why it isn’t happening now. Require an office visit co-pay for Medicare and Medicaid patients. I know most people with employer based healthcare have co-pays for office visits. They are an accepted part of health care costs.  Even a small amount like $5 or $10 for seniors and a dollar or two for Medicaid when you figure in the hundreds of millions of visits every year has to add up to billions.