As for "families able to pay for it out of pocket...few and far between," all my grandparents died at home (my home) and we were not rich. I believe the families financially unable to care for a dying person are few and far between.
Well, we're talking about two different things here. Caring for a dying person in the last days or weeks of life is one thing. Caring for a person who's permanently damaged in some profound way with no hope of recovery, but is still in no imminent danger of dying is another. That's the question I was asking re: who pays for it.
And to be perfectly clear: I wish we as a society had the resources to give every person the medical care they need or desire without regard to cost. But we don't. Somebody is going to decide how those resources are allocated...whether it's HMO's, the free market, or the government.
And no matter who makes those decisions, somebody is going to get screwed, and somebody is going to die when they could have lived a few more days, weeks, months, or even years with X number of dollars of finite medical care applied to their treatment. I don't like it, but that's the way the world works.