Advance Health Care Directive Form: Fill & Download for Free

In California, we have the Advance Health Care Directive as a statutory form. https://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdfI’ve used this, or versions of this that a health care provider utilizes, to cover end-of-life and other health care issues.I use this because it’s authorized by statute, accepted by physicians and hospitals, and empowers my wife to do what’s necessary.

A will is one of many means by which a transfer of assets is accomplished at the time of one’s death. Typically, it requires certain formalities, such as being witnessed. Also, property left by will may require a court proceeding known as “probate” to be implemented. Probate can be costly, time-consuming, and inefficient.A common alternative is the use of a living trust. It is called a “living” trust because it is created while one is still alive. A trust doesn’t die, and therefore it does not need to go through probate (with some exceptions).The term “living will” is very different. It refers to a directive concerning end-of-life or serious illness wishes. These days, terms more commonly used for this are “durable powers of attorney for health care” or “advance health care directives.” Informally, in the trade, we tend to call them “pull-the-plug” forms.“Estate planning” refers to the general process of taking prudent steps to ensure that one’s wishes for the transfer of property after death and related issues are satisfied. This includes asset transfer, guardianship of minor children, allocations of rights in some tricky situations (does the second wife get to stay in the family home or do the children of the first marriage get it, for example). Estate planning, done properly, involves legal, tax, financial, and other concerns.What one should use is highly dependent on the individual circumstances. Many people need minimal or no planning. Some people have situations that are very routine. People with substantial assets or complicated needs should consult with the necessary experts.If possible, have an initial consultation with an estate planning attorney, who usually is quite capable of assessing the overall situation. Try to get someone referred by a related professional, like an accountant or financial advisor. Don’t rely on advertisements. And shop around.

There is a reason the United States doesn’t have Universal Health care. It’s because we’re politically easily divided, and that means the folks who don’t want us to have it have significant advantages, politically. They are able to divide voters sufficiently to keep them from uniting in sufficient numbers to enact it.The pretext about cost: Many of us have been convinced that if we gave health care to everyone, it would cost even more than it does today. This is a strange argument, given that every country that does it that way spends less than we do per person. Still, the ‘more coverage will mean more expensive’ argument makes its own sort of intuitive sense, given that we spend lots of money already, and not all of us see a direct benefit from that spending. Our health care tax dollar is allocated from virtually everyone, to programs that not everyone is eligible to receive the benefits of. For example, I pay tax dollars into medicare (which benefits seniors and the disabled), for which I am not eligible. I pay into medicaid (which benefits the very poor) and to fund the VA’s health care program (which is for veterans) for which I am not eligible. Meanwhile, I am insured through my employer (which means a lot of money for my insurance was provided in the form of tax breaks to my employer), and the taxpayers indirectly underwriting my insurance aren’t eligible to participate in my policy.The benefits that come to me (in the form of taxpayer-subsidy to my employer-provisioned health care) aren’t visibly from the government, and the taxes I pay into the same government are very visible to me. This makes it very easy for folks like you and me to think the stuff the government does is for other people, none of it is for us- but nothing could be further from the truth:Americans with good jobs live in a socialist welfare state more generous, cushioned and expensive to the public than any in Europe. Like a European system, we pool our resources to share the burden of catastrophic expenses, but unlike European models, our approach doesn’t cover everyone.Like most of my neighbors I have a good job in the private sector. Ask my neighbors about the cost of the welfare programs they enjoy and you will be greeted by baffled stares. All that we have is “earned” and we perceive no need for government support. Nevertheless, taxpayers fund our retirement saving, health insurance, primary, secondary, and advanced education, daycare, commuter costs, and even our mortgages at a staggering public cost. Socialism for white people is all-enveloping, benevolent, invisible, and insulated by the nasty, deceptive notion that we have earned our benefits by our own hand. ~[Unspeakable Realities Block Universal Health Coverage In America]Another factor is that the solutions we’ve come up with so far have been sufficient to buy off just enough people to keep it out of reach, politically.There is history here.[1] Since the time America began to be an industrial nation it has wrestled with the impacts of capital’s adversarial relationship to labor, and health care would become a significant thread in the politics of it. For context, from the late 1800s onwards American labor and its new industrial barons faced each other in a world that saw the simultaneous decline of monarchy, the rise of socialism (and the advent of fascism) which would become the context for labor/capital relations going forward. Indeed, American right-wing capital fostered ‘red scares’ and became adept at race-baiting for domestic political purposes (those being to suppress and divide American socialists).Blessed with newfound industrial wealth, faced with contentious labor/capital relations and the advent of modern medicine (which started to become both more effective and expensive than it had been), Americans have recurrently fought over the idea of how best to organize health care.In the early 1900s, when doctors began charging more than most people could afford, the initial responses were individual pre-payment instruments, and the ‘blues’, (what would become blue cross and blue shield) emerged as private-sector solutions by which to finance health care. During this timeframe, the AMA emerged as a powerful entity in American politics, and it was very effective in squashing attempts to enact national-level social insurance programs that might give their patients more buying power than they thought would be good for them. Indeed, they were able to pressure FDR into dropping the planned health-insurance portion of what would become the Social Security Act of 1935.In the years after World War II, the western democracies that had not already done so adopted universal social safety net programs. These included health care, retirement and other benefits. President Truman introduced his plan for universal health coverage in 1945. It would have worked much like Social Security, imposing a tax to fund a universal insurance pool. His plan went nowhere. Instead, nine years later Congress laid the foundations of the social welfare system we enjoy today. They rejected Truman’s idea of universal private coverage in favor of a program controlled by employers while publicly funded through tax breaks. This plan gave corporations new leverage in negotiating with unions, handing the companies a publicly-financed benefit they could distribute at their discretion. ~[Unspeakable Realities Block Universal Health Coverage In America]It happens that employer-sponsored health care arose as an employer response to the Stabilization Act of 1942, which sought to control inflation during wartime by preventing employers from raising wages[2]. By way of an exemption to the law, employers were allowed to offer health insurance as a form of remuneration to keep the employees they couldn’t otherwise pay more. This, in turn, would give big employers a benefit they could use to lever workers against their unions.The Revenue Act of 1942 triggered another rush to enroll employees in health plans. By slapping corporations with tax rates of 80 or even up to 90 percent on any profits in excess of prewar revenue, Congress all but guaranteed a frenzied search for loopholes. Employee benefits, according to the new law, could be deducted from profits. As an anonymous employer observed in a study published on trends in health insurance, “it was a case of paying the money for insurance for their employees or to Uncle Sam in taxes.” ~[Employer-based health care was a wartime accident]Thus, we would establish (quite by accident) a tax-deduction-funded health care system for workers with good jobs- and this would in turn prove to be a good for many people- but not for everyone. In the much-vaunted 1950s onwards, the economic gains and middle-class growth would accrue almost exclusively to working-class white men, to whom jobs with health care benefits (with their invisible tax subsidies) were overwhelmingly reserved. This would prove to be a wedge that would be exploitable from then onwards- some portion of working class whites could be persuaded that if we afforded health insurance to everyone, it would come at their expense, and benefit undeserving “lazy” minorities.One other critical factor in the reason we don’t have universal health care today is that ever since the 1930s, Big-business conservatives have waged an ongoing (and well-funded) effort to promote the idea that less government regulation of their own interests (and much less in the way of taxing ability or popular support to do that) are vital. Their efforts would yield breakthrough results when they co-opted organized religion to their cause in the 1940s, and that in turn would foster a strain of Prosperity theology in American organized religion that would promote libertarian, anti-statist views from the pulpit, on behalf of their corporate patronage:Franklin Roosevelt had sold his New Deal to voters in part by explaining economic justice in terms of the Social Gospel, a progressive interpretation of Christian doctrine that casts sin not just as personal depravity, but as a cultural and institutional evil that demands a united effort to reform social structures and bring about the Kingdom of God.Leading industrialists struggled to counter this message until they found an ally in James W. Fifield Jr., a Los Angeles preacher who combined passionate hatred for the New Deal’s “encroachment upon our American freedoms” with public-relations savvy. In 1935 Fifield founded an organization called Spiritual Mobilization, which channeled donations from titans like tire magnate Harvey Firestone and Sun Oil’s J. Howard Pew into a publishing and propaganda campaign that urged ministers around the country to recognize “the anti-Christian and anti-American trends toward pagan stateism in America” and to promote the “free pulpit, free speech, free enterprise, free press, and free assembly.” ~[How Long Have We Really Been ‘One Nation Under God’?]Having recruited organized religion (and created televangelism as a thing) into the anti-statism chorus, and with middle-class labor threatened by the notion of universal health care costing them their excellent health care benefits, the Conservative-industrialist crowd were well-positioned to render the notion of universal health care (along with much of the rest of the New Deal and Great Society reforms) politically toxic. Indeed, every effort since (including those of JFK, Johnson, Nixon, and Clinton) have run afoul of well-funded political efforts by the following constituencies:The AMA, which is keen to avoid the sort of market changes that would occur if buyers had more powerThe now-incredibly-powerful private insurance industry, which is keen to preserve the status quo (which makes them a trillion-dollar segment of the economy)Class-insecure working conservatives with employer-provisioned health insurance, who worry that they’d lose their good insurance and pay a lot more for worse ‘public’ insurance that would be all used-up by poor people(because everybody know public insurance like medicaid is for poors, right?) Working folks are keen to shame those ‘sucking the public teat’, and doubly keen to avoid being shamed for doing the sameA strong component of this public-shaming of the poor and indolent is about race, given that class and race correlate so stronglyExclusion of the poor (and minorities especially) is a feature, not a bug, for many of these folks“because socialism” (many of these folks are assured that universal health care would destroy the economy because that’s what socialism does (never mind that the rest of the developed world has better health care and pay less for it than we do))Big business, which is keen to preserve its influence over its employees (control of health care is a big deal, and can be used to wedge labor out of unions), and still working on its long-game to reduce government to the role it had in their ‘golden age’ (which would be the time before the New Deal, and before World War II)Wall street- [Wall Street Was America’s First Foe in World War II]- to mobilize US industry into the war effort, wall street’s monopoly control of American industry had to be broken- a thing the erstwhile barons of wall street (and therefore, of America itself) want to restore.Organized religion, keen to maintain its political and cultural preeminence and standing within the conservative right.Not all of these groups know what the others are doing, or how they are being co-opted. At the individual voter level, many think they’re voting for the best of bad options, and few really understand that they are acting in the interests of a political coalition bent upon dismantling the United States government until it looks more like the one we had in 1907.So, all of that was a long way of saying “we don’t have universal health care because big money people don’t want that, and they’re very good at splitting up coalitions that would, if they united in common cause for mutual benefit, enact it yesterday.”Big money, organized religion, and racism. These are the wedges that divide us, and they’re why we bleed twice as much money into our hodgepodge of health care systems as the rest of the world’s wealthy nations do.Footnotes[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/[2] Employer-based health care was a wartime accident