Who decides? And when?

From kausfiles:

A debate on long-term cost control and end-of-life care--especially an emotional and acrimonious debate--is a highly useful debate to have. But it's not a useful debate to have right now. Right now it is killing Obama's universal care plans. ... And it wasn't a debate we had to have right now. It's a debate Obama has brought on himself by framing health care as an attempt to "bend the curve" of long term costs decades from now. He could have just said "Here's how I would guarantee health security for everyone. And here's how we're going to pay for it for the next ten years."

Kaus is one of the most insightful writers around. But here it's backwards.

We should have the discussion about cost control and end-of-life care first. How can we design change the system if we don't know what it will cover?

That's like saying: "Let's not worry about our destination. Let's just plan everything else about the trip."

Decide the destination first. Then decide the trip.

And Obama does bring up a good point. Why do we pay so much on the last weeks, when that neither prolongs nor betters life?

Most people don't want to be tormented at the very end of their lives. But they don't want a bureaucrat to decide when that will be.

But until we decide that, we can't really reform the system.