How To Die In America: Welcome To La Crosse, WI

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Excerpted from a article by Craig Hatkoff and Irwin Kula: One of the most intractable and politically charged problems in the U.S. healthcare system is end-of-life care. Unlike other third rail issues it only took two words—death panels—to put a screeching halt to the much needed public conversation about how we address medical care during the last six to twelve months of life. While she  managed to remove the payment provisions for end-of-life consultation from Obamacare, Sarah Palin’s quip about death panels also put the final nail in the coffin and the much-needed public debate was DOA. Unfortunately that didn’t alter the immutable facts about end-of-life management. It is projected that total U.S. health care expenditures will reach $5 trillion by 2022 from its current level of $3 trillion. A disproportionately large percentage of  total national health care expenditures, roughly 2 to 1, occurs during the last twelve months of life with nearly 30% of all Medicare spending is incurred during the last six months of a patient’s life. The extrapolations for end-of-life care in the future are truly sobering.

We all know there are no silver bullets when it comes to healthcare, but one very promising opportunity to dramatically improve the “tenor of care” during the inescapable end-of-life process for all Americans is the use of a legal form know as an “advance directive.” This document, which varies from state to state, typically includes a living will, a durable power of attorney and/or health care proxy. The advance directive gives legal authority to implement the wishes of a terminally-ill patient once they become incapacitated in regard to what medical interventions should be administered. This includes decisions such as intubation, cardiac resuscitation and  pain relief. Last week the Institute of Medicine released its 500-page report entitled “Dying in America” providing an opportunity to re-engage in the public conversation. The report concludes that “ a person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority.” But how does one go about doing so given that only an estimated 25-30% of Americans have executed advance directives. Are there any models out there that we can look at?…

Read the full Forbes article online on the Off White Papers blog. Originally written by Craig Hatkoff and Irwin Kula and published on September 23rd, 2014, the Off White Papers are part of Forbes’ Leadership section, contemplating the deeper, disruptive angles of historically and emerging innovations from healthcare and politics to arts and culture.  


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