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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 decision.

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 problems.

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.

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