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Miyamoto Musashi was a serious man.

The warrior-poet walked the medieval Japanese countryside seeking duels with the strongest warriors he could find. He lived a pure ascetic existence. He didn't care where he slept. He carried no money or food. And when too old to fight, after a life on the edge of mortality, he wrote philosophy in a cave.  

So, pretty much the exact opposite of the modern American lifestyle.

Yet as our country grapples with a dangerous debt/deficit problem, caused by demographic challenges and an overpriced and inefficient health care system, we should pay heed to two of Musashi's most important precepts. The first is to do nothing that is of no use. The second is to accept death in the midst of life.

In other words, Musashi would probably support "death panels" -- the concept of end-of-life counseling -- to guide treatment for the terminally ill. So do I. Here's why.

The twilight of life

First, we need to remember where the term "death panel" came from. The idea had fairly broad support until funding for it was included in Obamacare. Opponents framed it as government bureaucrats pulling the plug on grandma (when it was really about doctors being realistic with patients), and amid a backlash, it was pulled.

That was stupid. These questions demand far more serious discussion.

Anthony Mirhaydari

Anthony Mirhaydari

The fact is, 25% of all Medicare spending goes to the 5% of recipients who die each year --with 80% of that in the last two months of life. This is aggressive spending on things like stays in intensive care and critical care units, which research has shown do not meet the needs and preferences of terminal patients despite its increasing use.

Especially when combined with the growing evidence supporting the benefits of less-expensive, palliative hospice care that allows people to enjoy their last days on this earth in peace at home, not poked, prodded and intubated, floating in and out of consciousness under the fluorescent lights of a $30,000-a-night hospital room. 

The popular backlash against death panels gave politicians in Washington reason to fear the topic in general.

But by avoiding the issue, we're choosing to increase the burden on future generations by piling on debt, raising taxes, weakening our defenses, neglecting needed investments and generally damaging the future vitality of the country. This is nothing less than a slow-burn moral disgrace and a reversal of the archetype of parental self-sacrifice and responsibility. 

We can't have it all anymore. Think about that before you feign outrage.

If we're going to truly address the long-term budget problems that threaten the welfare of our children and our children's children, we need to address Medicare and, in particular, end-of-life care -- a topic that's been off limits since Sarah Palin unleashed the debate four years ago.  

We need leaner health care

Really, this discussion could be much broader.

One reason the economy's natural growth rate has slowed -- and resulted in a pitiful recovery from the 2008 recession -- is because government-led areas have become inefficient and overpriced -- and are underperforming relative to those of our global peers. Like a cancer, it's sucking precious resources from other, more productive areas of the economy.

I'm talking education, where we spend nearly 50% more per pupil than the average developed economy but rank in the bottom third in global math and science achievement rankings behind countries like China, Singapore, South Korea and Finland.  I'm talking about wasteful spending, which according to a Gallup poll, has Americans believing that Washington wastes 50 cents of every dollar it spends -- up from 38 cents in 1988. And I'm talking health care, where we spend far more per person than other rich-world countries, yet have mediocre quality-of-health measures, from infant mortality and hospital-borne infections to the fact that one-third of U.S. adults are obese.

These are areas that haven't been subjected to the profit-seeking, headcount-reducing, output-maximizing forces of globalization and technological change as broad swaths of the manufacturing, business services and retailing sectors have been.

But let's focus on health care, since it's the hinge on which the current budget fight turns. In 2009, Americans spent $7,960 per person on health care versus $4,808 in Canada, $4,218 in Germany and $3,978 in France. If we could reduce per person health costs, the budget deficit would melt away.

Truth is, our health care system lacks the discipline of a true single-payer, government-run system or the power of truly competitive, free-market forces.

This has allowed profits in the pharmaceutical and medical supply industry to soar, health care costs to consistently outpace the overall rate of inflation and truly haywire pricing. There's no reason an MRI should cost $1,080 in America but just $280 in France, according to the International Federation of Health Plans. Or why the cost of an MRI in Washington D.C. varies, depending on provider, from $400 to $1,861.