Quality and cost at the end of life: no need for trade-off's

A major reason US health care costs are so much higher than anywhere else while outcomes lag is that we waste so much money is wasted on end-of-life care. An article by Angela Maas in Health Plan Week provides a cogent, concise treatment of the topic. Some takeaways:

• Health plans cover palliative and hospice care but it is underutilized
  • Although palliative care discussions have a role early on, MDs don't want patients to think they're giving up on them
  • When terminal cancer patients come into hospice they may improve for a while --because they're not coping with chemo effects-- and such improvement may make them ineligible for reimbursement
• Patients receiving palliative care for non-small cell lung cancer from shortly after their diagnosis enjoy better quality of life and live longer (according to a NEJM study)
• High end-of-life costs are associated with worse quality of death in patients with advanced cancer (according to an Archives of Internal Medicine study)

One thing that's not discussed directly in the article but that needs to be addressed: hopeless patients on their last legs can be highly profitable for providers and drugmakers, who in a fee for service environment can make money from the very high utilization. It would be interesting to break down an oncology practice's profitability by stage of patient illness.I understand that each case is different and am wary of a slippery slope leading to euthanasia. But I prefer a frank discussion of these topics and addressing the cost implications head on.