As we all know, we have a collective healthcare cost problem in this country that provides plenty of fodder for our stories and plenty of challenges for the leaders who run healthcare organizations.
Fine brought up his idea with me a few weeks ago during an interview for an otherwise unrelated story on healthcare prices. A cancer survivor himself, Fine knows from running Banner Health that many of the problems with cost in healthcare happen in the last year of life. In 2006, 25.1% of Medicare expenditures went to patients for care in the last year of life, a number that has not changed significantly since at least 1978.
With advance directives required as a condition of participating in Medicare or even Medicaid, it's likely that many patients and their families would refuse some of this care, and thus, those decisions should have a pronounced effect on healthcare spending.
And for those of you who see "death panels" in this argument, don't even go there.
The beauty of an advance directive is that it lets you, the patient, through your agent, determine how far to go to prolong your life. Nobody else is making those decisions. You can fill out an advance directive that asks caregivers to use all tools available even if there is little to no hope of recovery. That's still your right, you're just being forced to make those choices while you are still able. Because when you aren't able, those choices default to using all those expensive tools.