Mandating advance directives

As the population ages, end-of-life care (EOLC) costs become an increasingly pressing subject. Advance directives (ADs) are legal documents that allow individuals to convey their decisions about EOLC. Although ADs have been shown to reduce EOLC costs, most people do not have ADs. To address this issue, we propose that Congress instruct the Centers for Medicare and Medicaid Services to collect ADs from Medicare beneficiaries. Because ADs can improve care and reduce unnecessary spending, this solution would likely be attractive to a broad coalition of support from providers, insurers, and the public.