I recognize that my advocacy for increased government funding for several purposes carries with it the obligation to push for reduced public expenditures elsewhere.

At some point, this will require being tough-minded about priorities – accepting the need to restrain spending on some programs that I believe are socially beneficial to free up resources for more pressing needs. But I happily phrase this in the future tense because we are not yet at that point.

There are significant savings that can be made with no loss of benefits. Some government activities, while necessary, consume far more tax dollars than can be justified. Others can be cut even more easily because they are not only unnecessary, but actually do more harm than good.

The military budget is an example of both. The $100 billion or so that goes every year to fund our self-appointed role as the world’s policeman is in the former category. The trillion-dollar cost of the Iraq war is an example of the latter, as are the tens of billions consumed at the federal and state levels by the war on drugs.

My focus today is on a third area where we can save a significant amount of money by changing a set of policies that not only do not advance our welfare, but also diminish it: denying ourselves the right to make rational choices about death.

Two public policy debates in the past 10 years frame the issue.

In 2005, I and other members of Congress were summoned to a special session to debate an extraordinary bill effectively forbidding Terri Schiavo’s husband to authorize the hospital where she had been lying for years with no signs of life except breathing to withdraw her feeding tube.

There was indisputable evidence that the Florida woman had told her husband that she did not wish to be kept alive by artificial means in such a situation. Contrary to claims by then-Senate Majority Leader William Frist and others that her eyes showed some consciousness, an autopsy confirmed that she had had no brain function at all for some time – including vision.

Despite this, over the objections of 65 mostly Democratic House members, the bill passed, and was promptly signed by President George W. Bush, who had flown from Texas to do so quickly. He did so in support of his brother Jeb, then governor of Florida, who had done everything within his power – and beyond – to maintain her in what he insisted was life.

While the petition forcing the re-insertion of the feeding tube was held unconstitutional by the U.S. Supreme Court, as it had been by 20 other judges who heard the case, Jeb Bush persisted, even seeking unsuccessfully to have her husband criminally prosecuted. (His continued insistence on this position makes this a relevant issue for 2016.)

Public reaction was overwhelmingly critical of this intervention by politicians into the case. But as is sometimes true, the greater political energy was with those who continued to argue that the law should prohibit any action that ended any vestige of life, even where the individual involved had expressed that preference, and the family members sought to carry out that wish.

This imbalance in the weight given to the issue – between the minority insisting on what they regarded as the inviolable sanctity of even the merest trace of life, and the majority opposed to the imposition of this view on those who differed with it – explains the deletion from President Obama’s health care reform bill of what seemed to us at first a noncontroversial provision authorizing Medicare to reimburse doctors for discussing end-of-life issues with patients.

It was wholly voluntary, but given the close margin in both House and Senate on the overall bill, and the provision’s link – however tenuous – to the right-to-life issue that was already roiling the debate, the Democratic leadership agreed to drop it.

Consequently, while there is no clear legal bar to a spouse, child or parent complying with the expressed desire of a brain-dead patient not to be kept breathing artificially, there is an aura of discouragement.

First, with the dropping of the end-of-life counseling provision from the health care bill, fewer people are aware of the availability – and to most, I believe the desirability – of creating an advance directive with their end-of-life wishes clearly spelled out.

Second, especially in the absence of an advance directive (but in some cases, even where there is one), some medical providers have varying degrees of reluctance to act. They are influenced to some extent by the fact that both times this has come before Congress in the past 10 years, the outcome has been supportive of the view that terminating any sign of life is wrong.

And this will be reinforced by the dynamic of the Republican presidential nomination contest, which will include Jeb Bush’s passionate views on this subject, and the support he gets on this issue from the potent anti-abortion movement.

The result is that we now spend tens of billions, mostly in Medicaid, on people who do not want care and get no benefit from it, while Republican governors in many states deny medical treatment to those who both need it and seek it because it will cost too much.

The remedy is to enact an improved version of the provision dropped from the Affordable Care Act and provide not just encouragement but also a legal safeguard to people we love and trust who seek to carry out our last wishes – saving public money and individual dignity at the same time.

Barney Frank is a retired congressman and the author of landmark legislation. He divides his time between Maine and Massachusetts.

Twitter: @BarneyFrank



CORRECTION: This story was updated at 3:27 p.m. on Aug. 10, 2015, to clarify that billions of Medicaid dollars are spent on people who do not want care and get no benefit from it.


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