re: I don't understand inheritance tax

There is zero inheritance tax of estates valued under $5.3 million dollars. It is part of the permanent tax code and yearly adjusts for inflation upward.

If someone leaves you with that you pay no tax.

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it isn't necessarily easy to distribute family wealth prior to a death either. someone will have to reference the actual numbers, I can't remember off the top of my head, but there's a "gift tax" on financial transfers within a family up to $10,000 I think is the number

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I hate the estate tax for many reasons, but if I'm not mistaken, it is pretty straight forward to gift money as you go. You basically have two options - annual gifts that are tax free if under $10k, or gifts that fall under the lifetime estate exemption.

For example, if someone is terminal and has $4M in assets, all in cash, they can transfer it to their heirs before they pass, all at once if they so choose, as it will fall under the lifetime exclusion under current tax law. They can also do nothing because $4M in assets will not be subject to the estate tax since it is under the $5.3ish million lifetime exclusion per spouse.

From what I can tell the only reason to take advantage of the annual gift exclusion is if you believe you'll have an estate over the estate exemption upon your death. No need to do so other than that, IIRC.