Bluntly, most of us will die on the government’s dime. The law of averages says we’ll spend many years being fairly healthy and about two years being extremely sick.

And those two years, spent in and out of hospitals and doctor’s offices, will cost the government programs of Medicare and Medicaid a pile of money.

As the nation begins a summer-long debate on health-care reform, policy makers would do well to consider one question thoroughly:

How can it cost three times as much to die in Miami, Fla., as it does in Norway, Maine?

A recent Dartmouth Institute of Health Policy study divided the U.S. into 306 hospital referral regions. It then obtained data on various forms of Medicare spending – in-hospital, outpatient, skilled nursing, home health and hospice.

After adjusting for age, severity of illness and inflation, the Dartmouth researchers developed a yardstick called the “Hospital Care Intensity Index” which measures time spent in hospital and the intensity of services and tests administered.

Stephens Memorial Hospital in Norway received a 4.3 HCI score and there was a total average of $36,377 spent per patient in the last two years of life.

Meanwhile, Westchester General Hospital in Miami, Fla., had an HCI of 99.5, with total end-of-life spending of $107,857.

While that’s an extreme contrast between Maine and Florida, that doesn’t mean there are not puzzling variations even within the state of Maine.

For instance, York Hospital received a 60.7 HCI, with average Medicare spending of $50,296, about $14,000 more than spent on an average patient in the Norway area.

For the record, total Medicare spending in the last two years of life was $54,273 for patients associated with Maine Medical Center, $44,060 at Central Maine Medical Center and $42,982 at St. Mary’s Regional Medical Center – all far lower than spent on patients in the Miami area.

There could, of course, be a simple explanation for all the variation, namely you get what you pay for. In other words, patients in Miami might receive more and better care than those in Maine.

More? Without doubt.

But better?

The Dartmouth study found that more spending does not necessarily mean better or more effective care.

The study also compared medical outcomes for general Medicare patients between two places, Miami and La Crosse, Wisc. After adjusting for variables like age, there was no difference in general health.

Which raises the billion-dollar question: Why is it we spend more than any country and yet have such mediocre results?

By nearly every metric – like life expectancy, infant mortality and hospital infections – the U.S. lags behind most industrial nations.

Today, 46 million Americans have no health insurance, families are driven into bankruptcy by exorbitant medical bills, companies have trouble competing and the U.S. government is rushing toward long-term insolvency.

Clearly, it is time to act. A new president, a new Congress, no pending elections, a public eager for change.

It’s time for dramatic change.