06/07/2011 02:17 pm ET | Updated Aug 07, 2011

The Medicare Crisis and End of Life Care

Medicare is on the minds of many baby boomers. It has been on my mind for a while, even before the current political wrangling about its fate. Let's face it; we have been here before, though the stakes seemed much lower.

I am not writing to make a political statement about Medicare. To be clear, I am biased in the direction of supporting all kinds of entitlement programs for seniors, as well as non-seniors. But I had a very interesting discussion recently with a patient about the impact of what Medicare actually pays for. He was talking with me about his advance directives. Though many of us don't like to think about it, advance directives are the decisions we make about end-of-life care or the kind of care that occurs when we are seriously ill. For example, if your heart stops while you are in the hospital, would you like to be resuscitated? If you can't breathe on your own, would you like to be intubated (receive a breathing tube)? And so on.

It turns out that modern medicine can do a lot to preserve us and we have a lot of choices in terms of how we want to live. My patient was talking about a recent New York Times Op-Ed article by Paul Krugman. He got worried that Krugman was suggesting that Medicare seriously look at the costs of end-of life care, as well as other expenses. I am not sure what Krugman was thinking -- and since the infamous Death Panel, um, "situation," in 2009, it seems quite scary for any person to talk openly about this aspect of end-of-life care for fear of saying something that can make us all very anxious and some incredibly angry.

Political dramas aside, what seems of paramount importance is that we not worry so much about what the government will do to us when we get to a point of being really ill, but what we, or our loved ones will do. The reality is, we all have a lot of choices these days, but it is a bit like gambling. Advanced life-saving procedures are a risk; they work, and many people recover. But depending on a myriad of factors, including illness severity, predisposing factors and quality of medical care, modern medicine may keep people alive, but not really living. Ever been to an intensive care unit? It is not a fun place. This is a risk that we all take in this unprecedented time of aging alongside incredible technological advances.

We should all take control where we can. Think about what you might want if you or your loved one were in a life and death situation; you can change your mind later if you want to. There is a lot we can blame the government for, but end-of-life choices are ours and if we don't take control over that, the villain du jour in government is not to blame. Take a positive step: complete your advance directives. Think about what you want and how you might want to live.