How health reform controls health cost
Secretary of Health and Human Services Kathleen Sebelius wrote a letter to the Washington Post defending health reform, citing another letter recently submitted to the House Budget Committee by 272 of America’s top economists. According to the economists:
“The Affordable Care Act contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending…
…The budgetary impact of repeal also would be severe. The Congressional Budget Office concludes that repealing the Affordable Care Act would increase the cumulative federal deficit by $230 billion over the next decade, and would further increase the deficit in later years.”
UPDATE: Here is an easy-to-understand animation explaining the Affordable Care Act, written and narrated by M.I.T. health care economist Jon Gruber (who advised both Governor Romney and President Obama on health reform).
UPDATE (01/20/2012): Under health reform, most insurance will now be required to cover contraceptives as a free preventive service. Preventing unwanted pregnancies should help control medical costs as well as reduce the incidence of abortion. (02/07/2012): In a new poll, 55% of Americans (including 58% of Catholics) agree that “employers should be required to provide their employees with health care plans that cover contraception and birth control at no cost.”
Join us on Facebook.
Follow us on Twitter.
January 8th, 2012 at 7:09 am
The first sentence you quote as coming from Kathleen Sebelius is obviously incorrect (not an incorrect quote, the statement itself is wrong).
The Affordable Care Act does not contain single payer and that obviously would be effective in reducing the rate of medical spending. In fact, probably much more effective then all the steps contained in ObamaCare combined.
January 8th, 2012 at 8:21 am
The direct quotes were from the letter by 272 U.S. economists to the House Budget Committee. I have edited the original post to make that clearer.
I agree with you that single payer would be more effective in reducing the rate of medical spending, but it would also have to include most of the same steps contained in “ObamaCare” to improve the quality of medical care. However, no elected officials are even proposing a national single-payer plan and it has absolutely zero chance of being enacted any time soon. The only political choice we have right now is “ObamaCare” or repeal.
If health reform is ruled unconstitutional by the Supreme Court or if a Republican is elected president and they take control of both houses of Congress and manage to repeal health reform, nothing else will be done for at least four years. All the benefits of health reform would be lost: health insurance companies would again be allowed to deny coverage to the people who need it most and health costs would continue to skyrocket. Even the next Democratic president may be reluctant to try expending political capital on an issue that failed for both Clinton and Obama.
As I have mentioned previously, health reform may provide the best chance of a path toward single-payer. It allows individual states the ability to experiment with their own means of meeting the goals of health reform. Vermont wants to try single-payer. If their experience proves to be successful, other states may follow them and build up public support for national single-payer.
January 8th, 2012 at 10:41 am
Look, I guess I am largely on your side on this issue, however I am unwilling to sacrifice individual liberties to solve the problem.
Perhaps we can reach agreement that the letter sent by 272 economists to the House Budget Committee is factually incorrect then.
They might try to muddy the waters with they are still correct that their opinion is based on one thing or another, but I am going to claim that it impossible for 272 to sign their signature unless they are either:
1. Intelligent and ignorant.
2. Intelligent, educated and lying.
3. Stupid.
January 9th, 2012 at 7:02 am
The current political choice is to continue implementing health reform or repeal it. Single-payer is not even on the table. The subject of this letter is the economic merits of the existing law, not an evaluation of nonexistant alternative proposals. The economists (who are not ignorant, lying, or stupid) said it contains “essentially” every cost-containment provision not every conceivable cost-containment provision. Even a single-payer plan would need to include these same provisions in order to control costs.
What sacred “individual liberties” are being “sacrificed?” The right not to pay a tax penalty? The right of insurance companies to deny claims? The right to die prematurely due to lack of medical care?
January 9th, 2012 at 9:47 am
Yes, the right not to pay a penalty for refusing to purchase a service from a private, for profit, corporation. I do not think you have considered what this additional government power could mean if the wrong people were elected to office.
I think that if the individual mandate is found unconstitutional (and I still hope and think it will be) there is still going to be a strongly, universal motivation to solve the problem of rising health costs. You might view such a ruling as a setback, I’d argue that it is really an opportunity. My argument is going to be “Well, we’ve tried everything else, perhaps now you’re willing to give socialized medicine a try.”
ObamaCare will only help throttle the increases, not solve the problem. Nothing the Republicans propose are going to solve the problem. The answer is going to become clear, and the American People will then start demanding Socialized Medicine because while socialized medicine might not be perfect, it does more to solve the problem within the limitations that humans can achieve until Jesus comes back and shows us how to do it better.
I wish to provide a caveat. While I am in favor of socialized medicine, I am favor of keeping it limited to keep it affordable. How limited? Well, I need expert advice from the medical community and I would need input from the majority of citizens for just how high a price tag they are willing to pay. I think every citizen will have plenty of time to develop an informed decision once they get around to agreeing we will have to have socialized medicine.
January 9th, 2012 at 12:14 pm
I don’t see “the right not to pay a tax penalty” in the Bill of Rights.
Suppose that the Supreme Court rules health reform constitutional, as three Courts of Appeal have already decided (including conservative appointees of President Reagan and President Bush – a former clerk for Justice Scalia), conservative legal scholar Orin Kerr (former clerk for Justice Kennedy), most other constituional scholars, and I think it will.
Then it will all come down to the political arena. If Obama is reelected, the current health reform law will continue to be implemented. If Romney (or any of the other Republican candidates) is elected, health reform may be repealed and then “nothing the Republicans propose are going to solve the problem.”
Where will the groundswell of “demand” for socialized medicine come from? Are the roughly half of the public and half of Congress who are Republicans ever going to be “willing to give socialized medicine a try?” I don’t think so.
The only hope we have is for “Obamacare” to be successful, and for the Vermont experiment to prove that socialized medicine is even better.
January 9th, 2012 at 12:20 pm
God help you (and all of us) if your point of view is right. The legislation under consideration was passed by a left leaning Congress and just how happy are you going to be when you are forced to then accept legislation when the right takes over?
Stop considering how it allows you to get what you want, start imagining how it might force you to accept what you do not desire.
January 9th, 2012 at 1:31 pm
Health reform was passed by a majority of the House and a two-thirds majority of the Senate and signed into law by the President, just like every other legislation. It will most likely be ruled constitutional by the Supreme Court. What alternative do you suggest to that process? What imaginary legislation will I be forced to accept if the right takes over? I am more concerned about the very real possibility that Republicans will take over and repeal “Obamacare,” leaving us no health reform for decades.
January 14th, 2012 at 11:24 am
Off topic post please forgive me. Please forgive me while I criticize you for not opening a thread where I could speak on topic.
Paul Hirschbiel has announced he will run against Scott Rigell. Evidently he has the support of the VBDC. I say he ain’t perfect, but until Jesus comes back we have to settle for something less. My praises to the VBDC, you did pretty well. Paul is a candidate we can support.
Now let me try to help Paul out a little bit. Perhaps he can help explain why an American Jew might vote for Barack Obama if he was faced with the only other choice was Netanyahu. If he explains it right, he’ll win my endorsement. He already has my vote, but if he wants to win my endorsement, that costs extra.
Paul needs to prove why he is just that extra special voice that is going to add something additional to the office he is running for. His opponent is not easy. Paul has my vote, but he needs a majority.
I would suggest that what Paul perceives as a weakness has the potential to be his strength.
I’m hoping we have a great candidate. If I didn’t think we probably did, I would not have even commented.
January 15th, 2012 at 3:41 am
On topic:
How would I improve the process? I would suggest that Congress should pass, and the President sign into law, only those bills which are constitutional.
You fear Republicans might repeal ObamaCare? Well think about it. If the Republicans have a large enough majority to repeal ObamaCare, then think about just what else they might do with that majority if the individual mandate is found to be constitutional. Might they privatize Social Security and force every American citizen to buy a retirement annuity from a private insurance company?
Be careful what you wish for. If your side has the power when they are in majority, the other side has that same power when they are in majority.
If it can’t be done right, it shouldn’t be done at all.
By the way, we might not have to wait for decades to get single payer if the individual mandate is found unconstitutional. While traveling through Berkley Springs, WV yesterday I saw this billboard:
What would Jesus do?
Start over.
Single Payer.
You might be surprised by who will support single payer if the individual mandate is ruled unconstitutional. It might not happen immediately, but it probably will not take decades for America to adopt some form of single payer. Surely you are in agreement that single payer would be better then ObamaCare, right? In my opinion, if we have to wait a little while to get the job done right, the time spent will be worth it.
By the way, I am not in favor of a 100% single payer program, it would actually be a hybrid. Only certain affordable medical care would be covered to keep the program affordable. Every American citizen would have the choice of whether or not they wanted to purchase supplemental coverage for medical procedures not covered. We can not afford to bust the budget to provide every American the latest, greatest, unaffordably expensive medical procedure. Perhaps such procedures could be added later when, after time, the cost comes down.
I am also going to be pretty picky about how we go about paying for the program. It should be paid for with a progressive income tax. The combined middle class would pay their own way, and the upper class would pay the costs for both their own class and for the lower class. Businesses should be freed from the burden of providing health care coverage for their employees so as to increase the chances goods with the label “Made in America” are available on the shelves at Walmart.
January 15th, 2012 at 5:13 am
I have copied your off-topic comment about Rigell v. Hirschbiel to an earlier thread entitled “Rigell v. Hirschbiel?”
You “suggest that Congress should pass, and the President sign into law, only those bills which are constitutional.” I agree. The Supreme Court gets to decide what is constitutional. Most constitutional scholars believe that the current health reform law will be ruled constitutional.
I do not have to “be careful what I wish for.” It is absolutely true that “If your side has the power when they are in majority, the other side has that same power when they are in majority.” That’s how our system works, whether I wish it or not. That is an argument for re-electing President Obama and electing more Democrats to Congress.
I am afraid of what the Republicans will do with the presidency and a large majority in Congress. They very well may privatize Social Security. President Bush tried to do it before, and Republicans will try to do it again regardless of whether or not health reform is ruled constitutional. That is an even stronger argument for re-electing President Obama and electing more Democrats to Congress.
There are only two realistic possibilities in the near term:
1) The re-election of President Obama and a Congressional Democratic majority, which will result in the continued implementation of the existing health reform law; or
2) The election of a Republican president and a Congressional Republican majority, which will result in the repeal of health reform.
If the Republicans have the presidency and “a large enough majority to repeal ObamaCare” how do you imagine they will pass single payer “socialized medicine?” Absolutely nothing was done on health reform during the eight years of the Bush administration. We would have to wait until the future election of the next Democratic president and Congressional majority (however long that may take). Do you imagine that such a Democratic president would look back at the political failures of Clinton and Obama and be eager to take on that divisive issue again?
I would be extremely “surprised by who will support single payer” since very few elected officials support it now and about half the public apparently believes “ObamaCare” is a “socialist” “government takeover.”
The best chance for single payer would be the demonstrated success of the Vermont experiment allowed by health reform.
January 15th, 2012 at 6:40 pm
You keep saying “Most constitutional scholars believe that the current health reform law will be ruled constitutional.” however I keep hearing otherwise on NPR. In fact, I can only recall one expert who put their reputation on the line with a predicted outcome and that prediction was that the individual mandate would be found unconstitutional by a 5-4 decision.
“Do you imagine that such a Democratic president would look back at the political failures of Clinton and Obama and be eager to take on that divisive issue again?”
Yes I do. Obama did not seem to have a problem tackling the problem after Clinton failed, did he? Whoever is successful in getting elected will have included it in why he/she was running in the first place.
In your “realistic possibilities” you left out a third real possibility.
3. The individual mandate is found to be unconstitutional and ObamaCare is then repealed in its entirety with strong bipartisan support.
January 16th, 2012 at 7:05 am
I have previously referenced many constitutional scholars who believe health reform is constitutional and have predicted the Supreme Court ruling won’t even be close, including Orin Kerr (a conservative who formerly clerked for Justice Kennedy) and Eva Rodriguez, Washington Post legal affairs editorial writer.
You have mentioned others who feel differently, but can’t ever seem to name anyone. Perhaps in their attempts to be even-handed, NPR was able to find someone to present the opposing view.
Here is a recent analysis that deals more specifically with each of the questions the Supreme Court has decided to consider.
The two appeals courts that have already ruled health reform constitutional included conservative appointees of President Reagan and President Bush II (who had previously clerked for Justice Scalia).
Justices Scalia and Kennedy would have to reverse their own precedent in Gonzalez v. Raich (which was itself based on 70 years of expansive interpretation of the Commerce Clause) to rule against the individual mandate.
I don’t believe that “ObamaCare” will be “repealed in its entirety with strong bipartisan support” is remotely “a third real possibility.” Congressional Democrats who fought hard for it will not vote to repeal it. Repeal would only happen as a result of a highly partisan vote by a Republican majority in the House, a filibuster-proof Republican majority in the Senate, and a Republican president.
January 17th, 2012 at 4:46 am
If the individual mandate is ruled unconstitutional, I believe there will be a majority vote to repeal and I would imagine President Obama would even sign it.
I have been doing a little research, during which I have been hampered by a slow and balky internet connection. One of the things I looked into, was what were the odds being given to the issue by bookies. Couldn’t find real odds (again, slow internet connection) but I found that one gambling site had 55% chance of it being found constitutional.
I think using Gonzalez v. Raich is a poor example of justification for the individual mandate because it ruled against a citizen’s right to grow an illegal substance on his private property. If you have the right to break the law in that way, why then would it not be legal to murder someone as long as you did so on your private property?
Constitutional scholars potentially have me cornered on Wickard v. Filburn, however I think this ruling is a travesty. I am wondering if this ruling might not have only come about due to the Executive Branch’s (FDR’s) threat to pack the courts if they did not start ruling in favor of what he was trying to do or something. But, in light of this precedence, I think that there is a difference between preventing someone from doing certain things when comparing it to forcing them to do something particular. In reality, I think Wickard v. Filburn is an awful precedent and should be overruled by the Supreme Court as it grants too great a power to the federal government to infringe on individual liberties. This has happened before, otherwise we would still be living with Dred Scott v. Sandford.
I realize that what I would be asking the Supreme Court to do is take a great leap in over ruling precedence, and such action comes with risks (if that precedence is over ruled, then is Roe v. Wade safe?). However the Supreme Court need not need take that extreme a step. Wickard v. Filburn currently defines the outer limits of federal power as exercised using the Commerce Clause. A majority of the justices need only rule that the individual mandate is a step too far beyond those limits as defined by the precedence. If the Supreme Court does not thus rule, then in effect they are ruling there are essentially no limits, and that the 10th Amendment has no meaning.
I wish to explain that if the individual mandate is not ruled unconstitutional, then I am not in favor of repeal of ObamaCare. Once the decision is handed down, the damage will have been done, so we might as well stick with it (ObamaCare). I still think a hybrid single payer would be better, but I must admit that it might take some time to garner majority support for it. As imperfect as it is, ObamaCare does solve many problems with our current healthcare system, so we might as well stick with it until American society is ready to adopt socialized medicine, and that might take some time.
I can empathize with those who are suffering under the current system and unwilling to wait for single payer. I guess I am being selfish when I state that it would be better for the greater good if the individual mandate was ruled unconstitutional. While some individuals might have to endure great hardship for awhile, such a ruling would probably result in a single payer system sooner then it will with ObamaCare being available. However my selfishness only is because I do not want to pay the price of my personal liberties since I am retired military and no matter how things go, I personally have medical care coverage for the rest of my life. My selfishness is in that I think nobody (including myself) should have to pay the tremendously high price of sacrificing individual liberties when a better, cheaper, more effective solution (single payer) is available to be chosen.
Perhaps I am a little selfish in doing so, but I am going to keep hoping for and arguing towards that which I think is for the greater good.
January 17th, 2012 at 8:11 am
You imagine Obama will repeal “ObamaCare?” That’s some imagination.
The Gonzalez v. Raich case was not decided on the basis of the illegality of the activity. The constitutional question was about the Commerce Clause. The Supreme Court ruled 6-3 that even an individual growing marijuana solely for his own personal use could substantially affect interstate commerce and therefore be subject to federal regulation that overrode state law.
Health care obviously has an huge effect on interstate commerce. Even “inactivity” (the choice not to purchase health insurance) shifts $57 billion per year onto the rest of us.
Ruling health reform constitutional would not mean “there are essentially no limits, and that the 10th Amendment has no meaning.” The appeal courts that have already ruled health reform conmstitutional were very careful to define the limits of their rulings, and the Supreme Court could easily emulate them.
You say “if the individual mandate is not ruled unconstitutional, then [you are] not in favor of repeal of ObamaCare.” Once the Supreme Court settles the issue in favor of constitutionality in July, we will be in agreement.
Regardless what the Supreme Court does, it will still be a political issue throughout the presidential campaign. Mitt “the father of health reform” Romney will apparently be leading the Republican charge to repeal health reform.
As reported on NPR this morning, repeal may be politically difficult because many popular provisions have already taken effect: 2½ million dependents now have health coverage, senior citizens are paying less for prescription drugs, free preventive care, etc. Congressional Republicans would also have to come up with $230 billion that the CBO says repeal would cost. Not that any of that would stop them.
January 18th, 2012 at 4:27 am
David,
If the individual mandate is found constitutional, it is hard to imagine that Republicans would win enough Senate seats to obtain the super majority needed to overcome the filibuster, although if they have a simple majority, there might be some arguing for changing the rules of the Senate (the nuclear option). As an aside, if this comes about, I bet you will stop complaining about the injustice of the filibuster.
I do not think that it is such a leap to imagine President Obama signing the repeal if the individual mandate is found unconstitutional. There probably will be enough votes to over-ride his veto, so he might as well as jump on board. However, I do not think that would be his primary motivation for signing it. The individual mandate is the keystone that makes ObamaCare work. That is why Obama changed to supporting its inclusion it even though he campaigned against it. (If you remember, that was one of Obama’s criticisms of Hillary during the primary, she was in favor of the mandate, he was not.)
I’m going to carry this to a bit of absurdity. Under current Supreme Court precedence, the federal government can pass laws preventing citizens from growing vegetables on their private property for their personal consumption. If the individual mandate is ruled constitutional, the federal government could also mandate that every citizen must purchase a quota of red meat. Unlikely? Yes. Impossible? No.
January 18th, 2012 at 6:36 am
“Absurd?” Yes.
January 19th, 2012 at 5:01 am
But is it possible? The answer is also yes, correct? Remember, a vast majority of us Americans are meat eaters.
(I do believe that a majority of us meat eaters really do not have a problem with anyone choosing to be a vegan or vegetarian, however the preaching annoys us, so…)
January 19th, 2012 at 7:59 am
Sure, anything is “possible.”
The two appeals courts that have already ruled the individual mandate constitutional were very careful to limit their rulings to the unique circumstances of health reform.
The 4th District decision (which included a Reagan appointee):
Greg Sergeant’s summary of the 6th District decision (which included a Bush II appointee):
I’ll make a deal with you. In the extremely unlikely event that there is ever a federal law mandating the purchase of red meat, you can have mine. I am fairly confident that I will never have to deliver on that promise.
January 20th, 2012 at 6:31 am
Well, I do not think that everyone consumes health insurance at the same levels and I do not think everyone should be forced to pay for it even if they have no intention of using it.
I will use a personal example. It is not a great one, but it is the only personal example I have.
8 or 9 years ago (I’ve lost count), my wife was told she had a terminal disease and that she had only about 4 months left to live. They told her that if she underwent radiation treatments, she would add several months to her life. She reluctantly agreed to undergo them, however after the 2nd one, she came home and told me she would rather die then undergo any more. Since then she has not been seeing any of the specialists to treat her disease. She developed high blood pressure, and she does see a General Practitioner to get a prescription to treat that.
When I discuss health care with my wife, she is adamant that society should not go broke providing the latest, greatest, most expensive medical procedures for every last citizen to give them just a few more breaths. If she chooses to forgo treatment, why should she be forced to help pay the costs for those who do not?
My wife is a good example in that she has given me very specific instructions on what choices I am to make as her spouse if she ends up in the hospital on life support. I am to tell them to pull the plug. In her mind, her quality of life is already bad and it is only going to get worse, so she does not want to waste the money prolonging her life. It irritates her that she might be expected to help pay the costs for those who are afraid of death and who might decide otherwise.
Where she is a bad example is in that her medical coverage is through TRICARE, which she receives by being the spouse of a military retiree. She has the choice that others might not have, although I would argue that this is only because I earned her that choice through my years of service.
January 20th, 2012 at 7:15 am
It is true that everyone doesn’t “consume health insurance at the same levels.” The whole concept of insurance is to spread risk over a large group.
The issue is not about people who have health insurance and choose not to use it, it is about people without health insurance. “Even if they have no intention of using” health insurance, everybody needs some kind of medical care at some point. If they aren’t insured, the cost of their medical treatment is shifted onto the rest of us. They are “free riders” (as Romney put it).
Your wife’s tragic example raises a completely different issue: end of life care. About 30% of Medicare is spent in the final year of life. About 50% of Medicare is spent on patients who die within two months. The extraordinary medical efforts usually do little to improve quality of life, they just temporarily prolong it. It is medically wasteful, but reflects personal decisions that are largely based on fear of death. Eventually, our mortality rate is 100%.
An early provision of the original health reform bill would have allowed doctors to be reimbursed by Medicare for end of life counseling so that their patients could make informed decisions about options such as hospice care and advance directives (“living wills”). Health reform opponents demonized it as “death panels,” “euthanasia,” “killing granny,” etc., and the provision was quietly withdrawn from the bill.
Regarding your personal example, I hope the “very specific instructions on what choices [you are] to make as her spouse if she ends up in the hospital on life support” are documented in an advance directive. If not, you may not be legally authorized to make the decisions she has requested when the time comes. In the meantime, take good care of your wise and brave wife.
January 20th, 2012 at 6:14 pm
My point was that those who, when faced with death, say “The end is near, so let’s get it over with” should not be forced to join the pool which includes those who will demand we bankrupt society, if necessary, to prolong their life.
I am slightly arguing against myself, seeing as how what I am actually in favor of is limited socialized medicine. My wife and I would still pay the taxes which pays for limited single payer. However my wife might put what we are in favor like this: “If you have a heart attack, head to the hospital and we’ll cover that. But if the Doctor tells you that you need heart surgery, you better have your own insurance.”
We’d cover the care and treatment for the heart attack. We’d cover continuing treatment of the type available before the days of heart surgery. But heart surgery? Well that’s expensive and you’d have to pay for that yourself. Since we’d go broke trying to provide it for everyone, it would not be included in the procedures provided for anyone. If YOU think you’d want it and YOU think it is worth it, well then YOU pay the premiums for the insurance that includes it and do not expect us to pay the premiums for you.
Some people might place a high value on prolonging their life, others might prefer to keep the money while they are young and healthy and use it to improve their enjoyment of life while they can. Why should the latter be forced to buy insurance from a for profit corporation which provides coverage for the former?
January 20th, 2012 at 7:47 pm
Perhaps you can educate me on the right to end of life issue.
My wife and I both are relying on that each can speak for the other when we can no longer speak for ourselves and the issue comes up. If we were forced to define all the circumstances where a legal document needs to define the circumstances, we would have to have a legal document the size of the Encyclopedia Britannica to cover all the possibilities.
My wife and I are just trusting in the judgement of each other. Grey areas exist which were not covered in our discussions, but I understand her wishes. I feel it would be impossible for her to communicate as clearly her wishes in a legal document what she was able to communicate to me because I have lived with her all these years, and a simple phrase expressing her will to me expresses more then everything a Harvard law degree enables one to fathom.
It is our understanding that as long as we are married, we each, one for another, get to speak for each other when we are no longer able to do so. Are we wrong? If we are wrong, the laws need to be changed to make it so. I do not desire that a legal document might be argued over by lawyers in a court of law and over-rule my wife’s attempt to fulfill my wishes.
Thus far, my wife is still willing to trust my judgement. With honesty, I think her only real concern is that I might be too reluctant to pull the plug.
January 22nd, 2012 at 9:08 am
An advance directive is a standardized legal document that is accepted by many states (including Virginia). It does not require a lawyer. It may include a “do not resuscitate” clause and a medical power of attorney that would allow you to make decisions for her if she were not able to.
January 22nd, 2012 at 3:09 pm
Perhaps I need to consult a lawyer or do some research. It is my (our) understanding that we already have to the right to speak for each other without any paperwork. A “do not resuscitate” order is too limiting. It depends on the circumstances as to whether or not resuscitation is OK. Rather then have an unthinking piece of paper speaking for me, I would rather have my wife do it. My wife’s problem might be that I would be on the road and several days away at the time a judgement might have to be made.
January 22nd, 2012 at 3:34 pm
An Advance Directive lets medical providers know the types of medical care you do and do not want in the event you are unable to express your wishes on your own. No need to consult an attorney, since stabdardized forms are available. Explanation here.
January 22nd, 2012 at 5:45 pm
I do not think I can cover all the circumstances where I want the Doctor to act and when I want him/her to keep his hands in his pockets. If I can no longer speak for myself, I want my wife to speak for me. Her voice might not be a perfect representation, but it would be a whole lot better then anything I could put on paper.
January 23rd, 2012 at 6:29 am
You are missing the point. If you can no longer speak for yourself, the paper authorizes your wife to speak for you.
January 23rd, 2012 at 2:45 pm
It is my understanding that in Virginia the paper is not necessary since we are married.
January 23rd, 2012 at 5:11 pm
The previous link was from the Virginia Bar Association. You don’t need an Advance Directive, as long as your wife is able to make the decisions you want her to without letting her emotions get in the way or as long as you don’t have other family members who disagree with those decisions. It is just a way to make it clear what your wishes are if you are not able to express them.