Yes, thank you. Your points are well taken. The reasons are very complex; more complex than I suggested in my post. I've mentioned before that I routinely have conferences in the hospital with patients and families about more intervention vs. comfort care.

We as a culture do not do well with our mortality and it is not unusual to see families demand high- tech, usually futile, and often stress-inducing procedures for very elderly parents near the end of their lives. We've mentioned here before that something like 80% of our health care costs occur in the last two years of life.

Physicians are rarely trained, nor are they comfortable, introducing an end of life conversation with a patient and their family. The specialists, in my experience, are even worse. The avoidance of reality, and the offering of yet one more procedure (sometimes because the doctor is uncomfortable and doesn't know what else to do and sometimes because families demand it) leads to a culture of more cost, more tests, more high tech gear, and more demand from patients and families to 'do something'. It's definitely a dance. The insurance companies play their part but we are all culpable in contributing to the problems we have today.