La Crosse: The town that knows how to die

La Crosse, Wis., the city described by Planet Money last year as “the town that loves death”, is getting Vox’s attention today for the same reason: Most people there have a plan for dying.

For several decades, planning for death has been part of the health care regimen in La Crosse, not much different than having blood pressure checked.

People were uncomfortable when doctors and nurses first started asking patients in the 1980s whether they had plans for end-of-life care, but they got over it without the braying about “death panels” that wasted the time and energy of the rest of the country.

The story of La Crosse — and how its approach to end-of-life care is quickly, quietly spreading across the Midwest — gives some reason to be optimistic about the future of end-of-life care in America.

It suggests that it is possible to move beyond death panels, and for doctors to have frank conversations with patients about how their life will end. The trick, it seems, is making these conversations feel like a natural part of the doctor-patient relationship, rather than a mandate imposed by a menacing bureaucracy.

The only problem is this: for programs like La Crosse’s to work on a national level, the federal government is eventually going to have to get involved — and pay doctors for this type of service. Is that something America will ever be ready for?

By 2008, 95 percent of the people in La Crosse had a health care directive. Researchers found those who died received the care they wanted.

People who die in La Crosse spend 32 percent less in the last six months of their lives compared to the average Medicare patient.

This suggests something broken about the way end-of-life care usually works: it is much more intense than patients desire. When patient preferences are known — as they almost universally are in La Crosse — people tend to select less aggressive courses of treatment.

And this is what has earned the La Crosse model so much praise: it’s shown a meaningful reduction in health spending as a side effect of respecting patient wishes.

The La Crosse model is spreading to the rest of the state, without state money.


It started a similar program — Honoring Choices — five years before La Crosse and supporters asked for state money in this legislative session.

“The day we introduced our legislation someone else dropped a bill relating to physician-assisted suicide,” says Sue Schettle, executive director of the Twin Cities Medical Society. “And I was thinking, ‘If there’s ever day where this issue would blow up, this was it. I was dreading reading the next day’s newspaper.'”

But the blowback didn’t happen, suggesting that in at least two states, people are pretty practical about what’s coming.