Before the middle of the twentieth century, most people died rather abruptly of infection, or in the late stages of untreatable illnesses like cancer and heart disease, or in accidents or battle. It was comparatively rare to die slowly in old age. Now, in the age of modern medicine, protracted deaths from cancer, heart disease, dementia, and frailty are far more common, triggering an ever-increasing need for palliative and hospice care. The current health care system in the United States encourages high-intensity care and high utilization of technology at the end of life while reimbursing comparatively little for services such as coordination of care and advance care planning and counseling. The emphasis on technology and treatment makes sense when it is possible to cure or to prolong a life of acceptable (to the patient) quality. But, when death is approaching, our system sometimes fails the patients who need it most.