THE BLOG
04/27/2011 04:18 pm ET | Updated Jun 27, 2011

Birth Certificates to Death Panels: Resurrecting Common Sense

On the day President Obama released his birth certificate, playing the ultimate trump card in the low-stakes sideshow that bizarrely captivated media, some federal courts and state legislatures, and the far-right for two years, can we dispense with "death panels" too?

Can we resurrect common sense more generally?

Andrew Sullivan and Ezra Klein have each advanced simple proposals to, either voluntarily or by mandate, have Americans fill out living wills. Klein suggests it as a requirement for Medicare, Sullivan says it is something everyone over 40 should just do.

Many organizations encourage people to fill out the simple living will template each state provides. There are various reports on the prevalence of living wills, most hovering near 36 percent of Americans, perhaps as high as 70% of seniors. But even after nearly 30-plus years of encouragement there are still issues with compliance by doctors and hospitals. The idea is right and making sure everyone has clear advance directives could represent significant health care cost savings to the government. This is what government can do and the private sector and human nature can't or won't: encourage adoption to increase prevalence by citizens and compliance by medical staff. People don't want to think or talk about death, so they don't act. Many doctors and hospitals view death as failure, and treatment as profit, so they don't comply with patient wishes in all cases. Mort Kondrake wrote in January suggesting that people spending their final days in hospice rather than intensive care could save up to $50 billion per year. "But the opportunity to choose," Kondrake wrote, "is even more important."

The fact that government requires everyone to have certain forms, for example, birth certificates, social security cards, drivers license/identification, doesn't seem onerous or invasive. Why should a form that clearly spells out the choices we want when faced with death? It is each individuals' choice what to put on the form; the form itself is neutral, as the government should be in all personal and private life decisions.

As Klein writes, "You could say cost is no object, and neither is pain or quality of life. You could make whatever choice, and offer whatever instructions, you want. You just have to do it. You have to make the decision."

The voluntary end-of-life counseling originally included in President Obama's Health Care Reform would have helped people understand this process and guide them in filling out these forms. It was dropped because of political demagoguery by the far-right. Sullivan acknowledges that his modest voluntary proposal won't achieve as much savings without government's nudging when he writes, "... frankly, I see no reason why the government shouldn't nudge you to make arrangements ahead of time given that others will be forced to pay the cost."

On a day when we learned the president of the United States is in fact an American, it seems as though common sense might make a come back, and so the timing of the proposals from Sullivan and Klein provide an opportunity to make another choice, besides how we want to die: how we want to live in and govern our democracy. Putting an end to the extremist's nonsense and allowing the government to make simple cost-saving policy changes like those suggested here, seems a good first step.