Every year about 5 percent of Medicare enrollees die. And before they die, Medicare spends a great deal of money on them.

We spend more than one in every four Medicare dollars (27 percent) on patients in their last year of life. We spend almost one third (32 percent) on chronically ill patients in the last two years of life.

Is this wise public policy?

First some good news. The fraction of Medicare dollars spent on people near the end of their lives has remained roughly constant over the past several decades. So things aren’t getting worse over time. Furthermore, there is some evidence that the spending decisions are not entirely irrational.