Our strongest suggestion is to consider a national policy related to advance care planning. Bluntly, the process by which many people die in our country is inhumane AND extremely expensive. Each day in America, there are complicated, often disharmonious debates occurring while another human being is attached to multiple machines and tubes. Families are often torn apart arguing about what “Mom or Dad” would want, while the person lies unconscious and costs accumulate quickly.
La Crosse, Wisconsin, has shown the country how to build a community-based system to engage individuals in conversations designed to elicit their personal wishes should potential end-of-life issues arise. The impact they have had on family satisfaction, clinical quality, and costs has been dramatic. The best part of the “deal” is this; following the tenets of advance care planning, individuals are free to choose their preferred course of treatment. In other words, the person who wants “everything done” is free to make that choice.
Practically though, communities like La Crosse have learned through experience that most do not want to have their life sustained by a machine when they are totally unaware of who they are or who they are with. They have learned the pressure on families is dramatically reduced, along with significantly lower costs. Advance care planning, done properly, is a classic “win-win” model that would provide several extremely positive benefits to the Medicare program without taking ANY decision making away from the individual.
In a country where it is legal for the government to mandate each person must have some form of healthcare insurance, why wouldn’t it be legal and desirous for each person to have an advance care plan appropriate for their age and condition? This is a “no brainer” if the goal is to improve the satisfaction of the people who are covered by Medicare and lower the costs attributed to Medicare. Everyone will win.
Scott Malaney, President and CEO
Blanchard Valley Health System
