It is said that in England death is pressing, in Canada inevitable and in California optional.Small wonder. Americans’ life expectancy has nearly doubled over the past century. Failinghips can be replaced, clinical depression controlled, cataracts removed in a30-minute surgical procedure. Such advances offer the aging population aquality of life that was unimaginable when I entered medicine 50 years ago. Butnot even a great health-care system can cure death—and ourfailure to confront that reality now threatens this greatness of ours. Death is normal; we are genetically programmed to disintegrate andperish, even under ideal conditions. We all understand that at some level, yetas medical consumers we treat death as a problem to be solved. Shielded bythird-party payers from the cost of our care, we demand everything that canpossibly be done for us, even if it's useless. The most obvious example islate-stage cancer care. Physicians—frustrated by theirinability to cure the disease and fearing loss of hope in the patient—too oftenoffer aggressive treatment far beyond what is scientifically justified. In 1950, the U.S. spent $12.7 billion on health care. In 2002, thecost will be $1,540 billion. Anyone can see this trend is unsustainable. Yet fewseem willing to try to reverse it. Some scholars conclude that a governmentwith finite resources should simply stop paying for medical care that sustainslife beyond a certain age—say 83 or so. Former Colorado governor Richard Lamm has been quotedas saying that the old and infirm “have a duty to dieand get out of the way ” so that younger, healthier people can realize their potential. I would not go that far. Energetic people now routinely workthrough their 60s and beyond, and remain dazzlingly productive. At 78, Viacomchairman Sumner Redstone jokingly claims to be 53. Supreme Court Justice SandraDay O'Connor is in her 70s, and former surgeon general C. Everett Koop chairsan Internet start-up in his 80s.These leaders are living proof that preventionworks and that we can manage the health problems that come naturally with age.As a mere 68-year-old, I wish to age as productively as they have. Yet there are limits to what a society can spend in this pursuit.Ask a physician, I know the most costly and dramatic measures may beineffective and painful. I also know that people in Japan and Sweden, countriesthat spend far less on medical care, have achieved longer, healthier lives thanwe have. As a nation, we may be overfunding the quest for unlikely cures whileunderfunding research on humbler therapies that could improve people's lives.