Thanks to the army of commenters. I've tried to read all the comments. I appreciate the bracing criticism of Marquis SeaToShiningSea and Economides as well as what I take to be the supportive comments from artappraiser and buck. Now I will take the opportunity, as Dan Quayle used to say, to stand by all my misstatements.

Let me stipulate at the outset that I favor more public involvement in health care, up to and including a single-payer system. Contrary to kgb999, I don't want to suggest market-based rationing is in any way superior to some kind of public make-over. In any system public or private there is some kind of rationing. The question will be, what kind? My fear is that rationing in a system reformed by Democrats will screen out treatments that can prolong life that is worth extending, from the standpoint of the patients themselves. It goes without saying that a system reformed by Republicans will suck, but they are not the ones presently at the wheel.

hoppycalif notes that not every life is worth prolonging. Of course I agree, except in my own case. I look forward to a system where the individual's choice is not constrained by cost. Aggregate cost should be a social, democratic decision. Should the individual be able to choose any treatment that might work? Yes, insofar as we as a society decide to insure ourselves to provide for this option. In this context, contary to Economides, it is NOT "somebody else's money." If you kicked in for the social insurance, it would be your money.

I was not trying to make a moral appeal, contrary to readytoblowagasket. I wanted to present it as a question of perception; how you look at a question in a state of repose, rather than under the gun. Some might say that in the actual event you will not think clearly. Fear of death will bias your decision. Well, making a decision in the sunny day of perfect health is biased too, just the other way. How often have you wished you took some kind of precautionary measure against an uncertain, unpleasant event, once such an event came to pass and it was too late for such precautions? Our lack of foresight is undisputed. I probably need a new smoke alarm, but I don't bother. Or course I'd regret it if the house burns down. Who is to say there has been a rational, collective judgement to avoid so-called diseconomical care? All we really know is we're spending a ton, compared to other countries, and not getting our money's worth.

A number of comments had the perspective of having 'been there' to experience an unhappy ending. Hence they reflect a resignation that is real in light of that experience, after the fact. But there can also be hope. People need to make their own decisions. If you'd just spent a year with 100 good days and 265 lousy ones, is that good enough, or is it time to call it quits? artappraiser raises this point. Ideally that would be up to you, nobody else. In principle there is no reason why we as a society should not insure for low-probability options. Maybe you've been there and are discouraged. But maybe you will get there and choose to fight. It could prove to be the right choice.

Am I paranoid? Fred M. and BobFred2 say no reform would deny a treatment. Maybe it's true, but I very much doubt it. A basic objective of reform, for me as for others, is to reduce the growth of costs. buck talks about this. As I said in my post, you can reduce quantities or prices or both. I am wary of quantity reduction, what Fred calls "prioritization," by whatever means. With enough nudging, there will be some patients moved to abstain from treatment, some providers discouraged from raising it as an option. I would work from the side of squeezing prices.

Economides makes the interesting point that reduced prices would spur the provision of increased services. I don't doubt it. But couldn't the converse be true as well? I suppose a public system will have controls of some sort on both sides. My view is beware an imbalance on the side of reduced services, especially under the rubric of canards of "last year of life" and "heroic measures" and "we (sic) can't afford more (socialized) health care." Economides describes how the best care is provided, but he or she doesn't say what makes that possible.

Marquis de SeaToShiningSea says I have no experience with crappy private health insurance. My experience is this: if you get really sick, you will burn through your out-of-pocket maximum. If you're not poor, that's not so bad. If you stay sick, you will get suggestions that maybe you should think of hanging it up, make your way to the nearest Hospice. If you are not sick enough for hospital (require "acute care"), but too sick for home, you are in the land of give the nursing home or home nursing providers all your money, and give all your time to the afflicted. Is that crappy enough? I suppose it could be worse. We've gotten pretty much any treatment we wanted, as much as we wanted, and gosh darn it we're still here, keeping the meter running, having some good days and some bad ones.

The Marquis seems to think I'm defending private insurance. No, I'm trying to avert bad public insurance. Single-payer is not on the table. Neither, Goshen, is paying doctors salaries. Instead we're getting some kind of convoluted reincarnation of HillaryCare. Private insurance sucks, end of story. Will HillaryCare ObamaCare be better? We don't know yet. Marquis provides a little list of low-hanging fruit in health care savings, one that I agree with. Now, is this the fruit harvested under the pending reform? Tell me it is, and I'll feel better. More evidence about treatment efficacy would be swell, but that's one thing. The other is, how is this information going to be used.

I have to object to the Marquis' momentary attack of Econ 101, the nostrum about scarce resources. Sure, a dollar spent on health care is a dollar not available for something else. Thing is, there are more dollars every year, and there will be more health care every year under any imaginable circumstance. The question is how much more, before we say not a dollar more.

I haven't been there. I am there now. Again, let's focus on a broadened perception, on a reasonable decision. Naturally the situation pushes emotions to the surface, but let's just try thinking. If my wife dies, the big bucks expended over the past year will be chalked into the "spent in the last year of life" column. She was in ICU on a breathing machine, heavily sedated, three weeks ago. We were asked (me, really) if we wanted this; the real question was, are you ready to check out? We said hell no, plug that sucker in. Today she's eating roast beef and watching the cooking shows. A little Dilaudid helps you through the day, and it's not a bad day.

The U.S. is a rich country. We can afford desperate measures that sometimes work. We can decide collectively to insure for them at some level. I would put the level high. You may not think you want them, but if you are there, shielded by insurance from the influence of cost, you may think differently. Will you be wrong?