Andrew Sullivan notes that if people were a little more responsible about planning for our own demise that this could reduce health care spending:
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, 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.
Of course put in terms of “everyone” it’s creepy and totalitarian. But he reels the idea back to “How about an easily reached website that makes such a legal process easier to accomplish?”
That certainly seems like a good idea to me. Although as with most good ideas about reducing health care spending what’s good about it isn’t so much that it reduces health care spending as that it seems like it would make people better off. Nobody likes to spend time pondering our own mortality, but lots of us would do well to take at least a little time to consider in advance how we’d like to end our lives.
To me, this is the general shape of the Medicare problem. It’s not so much that it “costs too much” as that relative to what it’s projected to cost in the future it doesn’t deliver enough value to retirees. If you’re 77 years old and receive a medical diagnosis that implies you have eighteen months to live without treatment, the government will spend large sums of money on trying to extent your life twelve months further. The government won’t pay for you to take a trip to visit the Church of the Nativity in the West Bank or to see Michelangelo’s David in Florence. But would it be so crazy for a fatally ill 77 year-old art lover who’s never been to Italy to prefer the chance to see her favorite artists’ iconic works in person over the chance of receiving extra medical care? I don’t think so. The point of our retirement programs should be to deliver high quality of life to senior citizens, and that militates at the margin for more Social Security rather than more Medicare. But the way our programs are set up, per retiree Medicare spending will grow much more rapidly than per retiree Social Security spending. That’s not the most cost-effective way to deliver high-quality retirement to people.