LOS ANGELES, Aug. 12 (Xinhua) -- Do seriously ill Americans have to stand before a "death panel" or they have to make "end-of-life" decision? That has become a focus of attention in the health care reform debate in the United States.

    The "death panel" issue prompted public concern after former Republican vice presidential candidate Sarah Palin wrote in a Facebook post Friday: "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of (President Barack) Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

    Since than opponents of the Democratic health care reform bill talked much about the "death panel" and that forced President Obama to say at a town hall meeting last week that Americans should not listen to efforts by those seeking to "scare and mislead the American people."

    "Where we disagree, let's disagree over things that are real, not these wild misrepresentations that don't bear any resemblance to anything that's actually being proposed," said the U.S. president.

    When one woman said she'd been told that the policy requires everyone of Medicare age to be visited and told they have to decide how they wish to die, President Obama said: "Nobody is going to be forcing you to make a set of decisions on end-of-life care based on, you know, some bureaucratic law in Washington."

    Critics said both parties are being hypocritical over the issue of end-of-life care. Since it is too sensitive, only few people dare to talk about it openly, but the problem really exists.

    The health care reform bill put forward by Democrats in the U.S. Congress includes a section allowing Medicare to pay for voluntary counseling about end-of-life care. Democrats held that offering an on-demand counseling session is hardly the same as establishing a "death panel" to determine which senior lives or dies.

    But Republicans tried to equate the two and that caused a lot of confusion.

    Both parties realized that the present Medicare system provided by the federal government for seniors 65 years old has a serious problem and consumes too much of the federal revenue.

    A quarter of all Medicare spending takes place in a patient's final year of life, and studies show most people facing a terminal illness or simply very old age prefer less medical intervention to more. That suggests the potential for savings.

    Last year, the U.S. government spent 455 billion dollars on Medicare, which is 15 percent of the federal budget, to cover 46 million Americans. Medicare spending is projected to skyrocket to 20 percent of the budget by 2019 as baby boomers increasingly become eligible for the program.

    According to the U.S. Census Bureau, in 2010, 40.2 million seniors 65 years and older will be eligible for Medicare. That number is projected to rise to 54.8 million in 2020 and 88.5 million in 2050.

    A report earlier this year showed that because of rapidly declining revenues, the Medicare trust fund for hospital expenses since last year has been collecting less in taxes and interest income than it pays out in benefits.

    Worse still, the Medicare trust fund's reserves will be exhausted by 2017. Medicare's total unfunded obligations, including its programs that use general revenues to pay for doctors' fees and prescription drugs, have reached 37.8 trillion dollars.

    Charmaine Yoest, President of Americans United for Life, said in a blog post that health reform "must respect life, and not contain provisions that mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the terminally ill, the chronically ill, or the permanently disabled."

    But Holly Prigerson, professor of psychiatry at Harvard Medical School, said: "As the nation looks to ways to improve patient care and reduce costs of health care, end-of-life conversations should be considered."

    The Chicago Tribune said in its opinion section: The fact is that end of life health care is siphoning off more than its share of our health care resources.

    The paper said right now the default setting for the U.S. health care system is to spend, spend, spend in the last stages of life even when there is no chance of recovery.

    "We should go into the end of life with eyes wide open as to our health care options. Americans should be glad that congress is trying to address this within the health care reform bill. Part of being a responsible citizen is to make a well considered assessment of our own feelings about end of life issues with recognition of how our own decisions will affect the lives of others," the paper said.