When you next go to the doctor's office for your annual Medicare-paid-for physical or if you just turned 65, your Welcome-to-Medicare physical -- a new benefit this year, thanks to health care reform -- the doc may want to talk about your death. Don't get scared. It's happening to everybody eligible for Medicare.
Beginning this year, Medicare will reimburse docs for the time they spend initiating an end-of-life planning discussion. The doc will ask you to sign an agreement in advance about what you want to happen if your heart stops, you can't breathe without a breathing machine, and/or you are otherwise in a vegetative state and aren't likely to rally. You'll also be asked to state whether you want to donate organs and other tissue after you die.
Proponents of this new aspect of retirement planning say it will provide opportunities for people to talk about a tough topic while they are still able. The discussion with the doc is confidential. You don't have to share it with anyone, although legal experts say that storing a copy of this agreement someplace where family can easily find it when it is needed can save everybody a lot of grief.
It also could save taxpayers a lot of money. A 2009 study published in the Archives of Internal Medicine found that late-stage cancer patients who received end-of-life counseling incurred 36 percent lower health care costs in their last week of life compared to patients who didn't make choices in advance. This isn't a small amount of money because more than 25 percent of the annual Medicare budget is spent on end-of-life care for the 5 percent of beneficiaries who die each year. Moreover, higher costs were associated with the worst quality of death -- more pain and indignity, the study found.
I cringe when I think about life ending this way. I'd prefer to go to bed feeling good and just not wake up. But it's a fact of retirement that many of us won't be that lucky, so let's have that end-of-life talk.