The 507-page report, “Dying in America,” said its recommendations would improve the quality of care and better satisfy more patients and families. It also said the changes would produce significant savings that would help make health care more affordable.

“If you meet their needs, treat their pain, treat their depression, get them some help in the house, your costs plummet,” said Dr. Diane E. Meier, a committee member and the director of the Center to Advance Palliative Care. Fewer patients would end up in emergency rooms getting expensive care they do not want, she said, adding, “It’s a rare example in health policy of doing well by doing good.”

The report’s linking of end-of-life choices to economic savings is likely to fuel criticism that the medical establishment and insurers will subtly pressure people to reject life-sustaining treatment in order to save money. This idea ignited intense controversy and killed a proposal for advance care planning in the Affordable Care Act when Sarah Palin and other conservatives raised the specter of government “death panels.”

One critic, Burke Balch, the director of the National Right to Life Committee’s Powell Center for Medical Ethics, said in a statement, “The report’s emphasis on cost-slashing will intensify, rather than calm, the well-founded fears of older people and those with disabilities that the renewed push for government funding and promotion of advance care planning is less about discovering and applying their own wishes than about pushing them to accept premature deaths.”

Leonard D. Schaeffer, a panel member who founded the insurance company WellPoint and is a professor at the University of Southern California, said the committee’s most “radical conclusion” was that there should be a more pronounced shift away from fee-for-service medicine, which promotes an emphasis on medical interventions in part by reimbursing doctors based on procedures rather than for talking with patients. “That’s all got to be changed,” he said at a public briefing. “And if you can’t do it with current law, guess what? You’ve got to change the law.”

Dr. Pizzo said that in surveys of doctors about their own end-of-life preferences, “a vast majority want to be at home and as free of pain as possible, and yet that’s not what doctors practice.”

Palliative care skills should be extensively taught in medical, nursing and social work schools, the panel recommended, something that Dr. Meier said would “require a revolution in health care education.” Many doctors are uncomfortable or ill equipped when it comes to broaching the subject. To ensure consistency and quality of palliative care, there should be “pretty dramatic change in all the certifying boards, accrediting boards and regulatory entities,” Dr. Pizzo said.