Health care reform proposals are doomed to failure unless and until something is done about the exploding costs of end-of-life care.  Through heroic medical interventions the dying can be kept alive a few days or weeks longer at enormous expense, notwithstanding the fact that their chances of survival beyond the immediate period, and quality of life, are both zero.  It's not surprising that a high percentage of the typical American's lifetime health care costs are incurred in his or her last 30 days of life.  No other developed countries even approach our levels.  And no, having a more rational approach toward the dying hasn't turned the Europeans or Japanese into heartless barbarians.