Society and the US medical system have come a long way in improving end-of-life care. It is far, far from ideal, but it is also much better than it was 35 years ago when research on how to improve end-of-life care was just beginning. Historical perspective makes clear what is necessary to accelerate improvement: change payment models to make health care organizations and clinicians more financially responsible for end-of-life care so they will focus attention on improving it, and enhance the infrastructure to make it easy to deliver more palliative care at home 3 to 12 months before death.