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I was not that people do not want that conversation; folks talk about it quite often.

People talk about end-of-life decisions in a personal context quite frequently. In my personal experience (and I could be wrong), they rarely talk about whether societally we should consider whether we are allocating a disproportionate amount of our medical resources to interventions among the very very old, instead of (perhaps) towards the young or poor. And politicians - who I was talking about - never have that conversation if they can help it, even though those expenditures are being covered by government medical insurance (for the most part).

So we don't have policy discussions about whether or how Medicare might review its spending among the exceptionally old cohort, whether we might improve overall health outcomes by reprioritizing resources to the young and poor, and how we might be able to do this without compromising patient care. The health care law contained a tentative approach towards that subject, and it prompted such a pushback that it was dropped quickly.

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