OTHER THAN THE MANDATE, DEATH PANELS WERE THE BEST PART OF THE BILL:

Health care outside of Medicare follows a similar pattern, with research showing that the majority of U.S. spending also highly concentrated on a small group of high-cost patients. These typically include people with one or more chronic conditions, such as diabetes, high cholesterol, arthritis and cancer, said Steven B. Cohen, a director at the federal Agency for Healthcare Research and Quality.

The majority of that spending is unavoidable, but research shows a large portion isn't. Of the $2.5 trillion the U.S. spent on health care in 2009, $765 billion was waste, according to a study by the Institute of Medicine, an independent body that advises the federal government on health policy. That includes $210 billion on unnecessary services.

Health-policy experts say another way to tackle that problem is to give patients a better sense of their survival odds once they get really sick. Some are pushing for private insurers and hospitals to release data that would help them create better statistics on how long patients survived after long hospitalizations or with particular ailments.

"If you knew to say, 'I'd like to see how the last people who were relatively similar to my mother did,' think how important that would be," said Joanne Lynn, a director at the Altarum Institute, a nonprofit health-systems research organization, who has worked for the agency that runs Medicare and Medicaid. "Right now, the doctors are going on hunches."

Many experts say the key is to get patients to plan with doctors and their family for how much care they want when they approach the end of their life. Medicare doesn't currently reimburse doctors for visits devoted to that since the change was labeled a "death panel" and struck from the health-overhaul law. The cultural aversion to talking about your own death also hinders such planning.

"In this death-panels nonsense we have lost the ability to talk about a very important matter," said Donald Berwick, a pediatrician who ran Medicare and Medicaid until last year.

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