Medicare plans to reimburse doctors for conversations with patients about medical treatment at the end of life represents an important step forward for public policy in health care. It also signals a welcome shift to a more open attitude toward a subject most people would rather avoid. In short, the agency is proposing to support open discussions with medical professionals about the way we want to die. Decisions by Medicare, which insures 55 million older Americans, often set the standard followed by private insurers as well.