I’m following the nation’s health care debates with great interest, as I assume most of you are as well. As a partner in a small law firm, I’m keenly aware of how costly it is to provide health insurance to our own families and to our employees – yet how important having adequate health coverage is. Like most employers, we can’t go on shouldering thirty percent annual health insurance premium increases year after year, and that’s probably one of the many reasons health reform has been such a hot political topic.

 So President Barack Obama presents his plan that would presumably introduce the concept of a government provider that would compete with private insurers. Apparently his theory states that a government provider would create competition against private insurers resulting in lower health care costs.

I’m personally skeptical of the government’s ability to manage a national health plan that would result in lower costs, and point to Medicare and Medicaid as historical examples. Present forecasts predict that current tax revenue will not support Medicare and Medicaid into the next generation without significant tax increases, benefit cutbacks, or both.

While I’m not smart enough to know all of the right answers, when I hear about state law barriers that prohibit insurance firms from crossing state lines, or all of the myriad of rules that differ from state to state that result in practical limitations on private insurers from competing in certain markets, I wonder whether there are other answers besides having the federal government fill the role as our nation’s primary health care insurer for those of us who are working or school age.

But that’s for others to ponder.

Today I want to consider one of the juicy topics that’s actually lead to fisticuffs in town hall meetings. The background is that as a nation it’s been reported that we spend a significant percentage of our health care dollars on the very last weeks of life. These dollars often do not lead to any more quality of life for the patient.

The worry (whether real or imagined I can’t tell) is that under a government sponsored program, there will be “death panels” that will determine whether dollars should be spent on a patient’s terminal condition, kind of like the Roman spectators giving a thumbs up or thumbs down at the end of gladiator matches. It’s a chilling thought to wonder whether a diseased Lance Armstrong would have survived such a tribunal back when his prognosis looked bleakest. Would we now have the seven time Tour Champion raising millions of dollars for cancer research or would he have been relegated to his deathbed before he was able to achieve such greatness?

And that’s precisely the worry that many express while signing living will documents. You may already know that living wills are the documents that allow you to declare ahead of time whether you would want life prolonging medical procedures withheld in the event it was determined by two physicians and your health care surrogate that you are in an end stage terminal condition or a persistent vegetative state with no hope of recovery.

The Terri Schiavo case just up the road in Pinellas County highlighted what might happen if one doesn’t have a living will and ends up in such a condition. Nevertheless, I have had several clients express concern that the living will essentially gives the doctors the ability to form one’s own “death panel”. If the doctors proclaim that there is no hope of recovery, then the life support is terminated.

I don’t believe that to be the case. In my twenty years of practicing estate planning law, I can’t recall an instance where a client’s family has telephoned me with the worry that the doctor or hospital is going to turn off the life support against the family’s consent. While you might point to Terri Schiavo’s parents as a prime example, remember that she didn’t have a signed living will document, which lead to the controversy over her care.

When my wife’s great uncle died a few years ago, the family sat by his side and held his hand when the life support ended. By then he was comatose while a morphine drip was administered to alleviate any pain. Everyone agreed that the heart and lung machines weren’t going to bring him back. While it was a sad time for the family, we all realized that life isn’t infinite.

These are weighty decisions. It’s interesting to watch our society struggle with life and death concerns, and how our resources are allocated accordingly. As citizens I believe we have a duty to let our elected officials understand our thoughts and concerns.

©2009 Craig R. Hersch