Human Exceptionalism

Don’t Allow Government “Certified’ Advance Directives

The Medicare Choices and Empowerment Act seeks to promote advance directives. But it does so by having the growing the federal government’s intrusion into our private affairs.

First, it would pay Medicare beneficiaries $75 to fill out an advance directive (AD). The wisdom of having the government pay us to take care of our own business is questionable. But this being federal legislation, not just any advance directive will do.

Of course, there’s a catch! From my piece, “The End-of-Life Bureaucracy:”

This being federal legislation, not just any advance directive will do. In order to qualify for the payment, the directive will have to be “certified” by the federal government and “executed in accordance” with the law of the state in which the beneficiary lives, not a federal standard.

Okay. But here’s the kicker: To be federally certified the advance directive must be “offered by an entity that has received accreditation from the Secretary” of health and human services.

To be an accredited supplier, the vendor would have to meet very onerous technical capabilities–detailed in the article.

The point of the law is to ensure that people have greater access to wanted expensive care, not just refuse it. Here’s the problem, as I see it:

Once the federal government gets into the advance directive “certification” and “accreditation” business, a Rubicon will have been crossed. It is not in the nature of government to remain a neutral arbiter. Given bureaucracy’s natural intrusiveness, the bill would, over time, almost certainly result in increased federal influence over the content of our end-of-life choices.

Protecting America’s weakest and most vulnerable patients from being deflected from requesting expensive care is important. But the best protection against that danger is less—not more—centralization. Enlarging the federal bureaucracy’s role in end-of-life choices will ultimately empower the federal bureaucracy’s control over end-of-life care.

Bottom line: A well-intended bad idea is still a bad idea.


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