Reducing end-of-life costs will do little to curb the growth in Medicare spending overall. But end-of-life care provision should be reformed to match the values of patients.

To reduce spending and more appropriately limit geographic variation in utilization among Medicare beneficiaries, the program should consider the utilization-management techniques employed in the private sector as a model.

Variations in service use across regions are smaller for the private sector than for Medicare, suggesting better management in the private sector.

I was initially assigned the working title, "Pursuing Equality in Health Care for the Elderly Is Futile." I prefer to think of that particular dead end of health policy as one of listening to the wrong music for too long. Hence, this article revises the title song of the movie, Urban Cowboy, to "Looking for better health [rather than either "love" or "love of equality"] in all the wrong places.