Clearly, what lies ahead is not your parents' Medicare but something new. A place where government will trump doctors, and it will be sold as safer, better, less wasteful care. There's not much patients can do except be informed as never before. Take advantage of health reform's offer of free regular end-of-life counseling to know your options. Have a living will that makes your views quite clear, and line up family members plus a good doctor who will support your wishes. Whatever Uncle Sam says, "Enough is enough" is a judgment that should be made patient by patient, one by one.