Why Medicare should pay for advance care planning

Abstract

Medicare does not pay for beneficiaries to undergo advance care planning (ACP). In this paper, I argue why this failure is economically unsound and unethical. I begin with an analysis of the data regarding current Medicare end-of-life expenditures. Research on these data demonstrates a failure of high-intensity spending to improve end-of-life outcomes. These data further show that ACP can effectively control end-of-life care costs since most persons who undergo ACP opt for palliative-based treatment at the end of life, as opposed to high-intensity medical treatment. I then discuss how current regional variations in Medicare spending on end-of-life care and the failure of Medicare to offer an ACP benefit to its beneficiaries is both economically unjust and appears to violate several tenets of medical ethics. Reliance on the Patient Self-Determination Act of 1990 is also refuted as an ethical solution to the raised concerns about Medicare's failure to fund an ACP benefit. I conclude by noting that the ethical force behind why Medicare should fund an ACP benefit is rooted in its conceptual goals as a means to align patient treatment preferences with the medical care they receive, and not simply the ability of ACP to help control end-of-life care costs.

Keywords:

• Medicare
• Advance care planning
• End-of-life care
• Economic justice
• Patient Self-Determination Act of 1990