Dan Popp
The government pays your doctor to talk to you about death
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By Dan Popp
May 15, 2017

On January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing for advance care planning (ACP) as a payable service for traditional Medicare beneficiaries. ACP is the face-to-face time a physician or other qualified health care professional spends with a patient, family member, or surrogate to explain and discuss advance directives. – American Academy of Family Physicians Website

File under: What Could Possibly Go Wrong?

The proposition seems innocuous enough. People get incapacitated and can't make their own medical decisions, so doctors should encourage patients to file Advance Directives (think "living will" and related legal forms). Also, many old people die expensively and painfully, so doctors should educate patients about palliative care, and dissuade them from taking heroic measures in the Emergency Room.

Here barbarians will declare that I'm against end-of-life conversations, or that I'm against doctors being paid. And more innocent strawmen will suffer needlessly. Oh, the compassion.

As Bastiat pointed out centuries ago, saying that the government shouldn't do X is not the same as saying that X should not be done. I'm not against your doctor being paid, or against your doctor talking to you about your future options. But there's something sinister, it seems to me, in the idea of government being a party to that conversation.

For now, as I understand it, these conversations are voluntary, and Medicare is only footing the bill, not mandating the content. But when you're paying for a benefit for someone else – like your teenager's car insurance – don't you feel that you should get a say in how your money is used?

We know that Emergency Room care is expensive, and Hospice care is less so. We know that the elderly now rack up disproportionately high health care charges in the last year of life. And because of our unconstitutional redistribution programs, these high costs become Medicare costs. How long before the government puts these facts together, and a casual conversation to document your wishes becomes a subtle "learning opportunity" to convince you to "do the right thing by the younger generation" that's paying?

To put it another way, if the government can force innocent strangers to pay for your choices, why can't it force you to make certain choices? The "Affordable Care Act," as we know, does exactly that: It restricts your choices of insurer and policy in the (false) name of cost savings.

Barack Obama already let this cat out of the bag:
    And all we're suggesting – and we're not going to solve every difficult problem in terms of end-of-life care. A lot of that is going to have to be, we as a culture and as a society starting to make better decisions within our own families and for ourselves. But what we can do is make sure that at least some of the waste that exists in the system that's not making anybody's mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn't going to help. Maybe you're better off not having the surgery, but taking the painkiller. And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decisions, and that – that doctors and hospitals all are aligned for patient care, that's something we can achieve.
Yes, little Barry, human beings must make hard decisions because of what grownups call "scarcity." But no, little Barry, the government does not have any rightful role in making those decisions for people who haven't broken the law. The Problems you're pretending to solve in the "system" were the Solutions of previous barbarians.

Let's talk about "incentives." As someone has said, to a private medical practice the death of a patient is a loss of revenue; to the government "health care system" it's a cost savings.

How are the incentives aligned when our lawless and bankrupt Ministry of Healing sees an aging population with exponentially expensive health care requirements, and on the other side of the ledger some cheap pain pills? What will happen next in this story?

The United States government is one of the most accomplished killing machines in the history of the world. Are you sure you want to include it in a 3-way conversation with you and your doctor about death?

© Dan Popp

 

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