There is a common misperception that palliative care is just another term for hospice care. Although it includes hospice, palliative care is also the long-term coordinated care of the chronically ill, which is delivered at a cost savings. Why does it matter that the average American understand what palliative care means? Because the evidence shows that U.S. patients near the end of life are spending exorbitant amounts of money on health care they do not want and the country cannot afford. To better understand why palliative care is an important issue in the current debate about health care reform, the authors first briefly review landmark legal cases in the area of end-of-life care. They then discuss the role of palliative care in conversations in the current health care climate and conclude by emphasizing the importance of integrating palliative care into the standard medical curriculum. The authors predict that palliative care will be accepted in the United States as a much-needed and desirable field of medicine. Getting there, however, will require a multifaceted approach including payment reform, encouraging an open conversation among the U.S. public, and training physicians to offer the best possible care and guidance until a patient's last breath.