Medicare wise to aid end-of-life planning

The world of health-care continues to roil, shift and change with the coming of age of the Affordable Care Act. Another major change is coming down the road, giving doctors who care for the elderly the option to offer end-of-life planning sessions and to be reimbursed by Medicare for that work.

We think this is the right approach. As our health-care reporter, Steve Lynn, notes in his coverage of the issue this week, Medicaid, the free health insurance program for the poor, and private insurers already reimburse for this kind of consultation. But Medicare, which covers more than 52 million Americans, including more than 686,000 Coloradans, covers the largest portion of the population that could benefit from such care.

Health-care executives will tell you that vast sums are spent caring for elderly people in the last one to two years of their lives. Frail seniors who haven’t been advised about what options are available and what the pros and cons of these options are – such as whether to have a do-not-resuscitate order in place or a feeding tube used in the event of a major stroke – can lie for weeks undergoing painful, invasive, expensive procedures that could have been avoided if they had had the opportunity to outline their care choices before they lost their ability to communicate with their families and caregivers.

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One health executive has gone so far as to suggest that in order to sign up for Medicare, each of us should present a signed living will and a medical power of attorney, showing what kinds of care we want at the end of our lives, in order to save the government billions of dollars in health-care costs.

That’s an interesting idea, although it raises troubling issues about how deeply we want the government involved in our health-care and end-of-life decisions. We’re not ready to endorse that idea yet, but we are supporting the current effort to have Medicare reimburse doctors for end-of-life planning.