The old Marx Brothers’ joke—“I wouldn’t dare go to the hospital—people die there all the time”—is essentially true. Many people die in the hospital—in many cases, just after they’ve incurred a hugely expensive round of surgery, treatment, and medication. About one-third of Americans undergo operations in the last month of life.

If these issues were subject to hard, cold economic theory, a health-care system would probably distribute spending differently. The large sums it costs to keep a sedated cancer patient with dementia alive in a hospital bed from age 94 to 95 could presumably be directed instead to provide, say, a kidney transplant for a 40-something victim of renal failure, or a young woman who is too depressed to care for her baby. That money could be used for pre-natal care for uninsured mothers, setting the stage for both mother and child to have a healthier and happier life. Or, those funds could be used to provide health insurance at reasonable cost to the 29 million Americans who have no health coverage today.

One famous, or perhaps notorious, advocate of limiting late-in-life medical spending is former Colorado Gov. Richard Lamm, who was given the nickname “Governor Gloom” in the 1980’s for his argument that the elderly have a “duty” to avoid costly care when the end is near. There’s only so much money available for medical care, Lamm noted, so it ought to be used in the most efficient way. In the face of bitter criticism, Lamm stuck to his guns. Just this spring he told the Denver Post: “When I look at the literature, and there are such things as $93,000 prostate operations at some stage of prostate cancer that might give two extra months of life, it is outrageous.”

The problem with these straightforward economic calculations is that they involve real human beings who have friends and relatives. That 94-year-old cancer patient, after all, may have loving children or grandchildren at the bedside; hardly anybody is willing to let Grandpa die just to save money for the overall health-care system.

The issue of allocating medical spending is most acute in the United States, because we spend far more on treatment and medication than any other country. All the other developed democracies on the planet guarantee health care for everybody (citizen or alien), and yet they spend, on average, about half as much per capita as the U.S.

But all over the world, health systems are struggling with the same concentration of cost that plagues the U.S.

The United Kingdom is a global leader in dealing with this concern, because the National Health Service provides care—with no medical bills –to 62 million Britons and another 12 million or so resident foreigners. Overall, the NHS works well; the Brits have longer life expectancy, lower infant mortality, and somewhat better health statistics than the U.S., at far less cost. But the British, system, too, is struggling with the enormous expense of treating the chronically ill and the aged.

So Britain created an organization to make rules for how its healthcare money is spent. It’s formally called the National Institute for Health and Clinical Excellence, but everyone knows it by its acronym: “NICE.” This outfit issues guidelines to the regional medical authorities on what should be covered, and what shouldn’t. Should a 94-year-old get a hip replacement? Should a terminal cancer patient be given a course of medication that costs $40,000 and extends life an average of four months? (In Britain, the answers are, generally, “No.”)