With advances in medical care, we simply can't have the taxpayers fund everything. Some things are going to have to be considered "nice to haves" and paid for by the patient (replacement joints as an example).

Late stage medical care is also going to have to be evaluated. My wife's aunt had open heart surgery at age 91. She was in great health (for a 91 year old) before she had the surgery.... other than a heart condition that could have killed her at any moment. She never fully recovered from the open heart surgery and died within a year of having the surgery with a terrible quality of life for that last year. And I can't imagine what that surgery cost.... probably $100K+. That surgery should have never taken place based on a) the risk/benefit tradeoff for the patient, and b) the cost/benefit tradeoff to society as a whole. Now if my wife's aunt was independently wealthy and wanted to have open heart surgery at 91, she should be free to do so (although I still think it's a bad idea), but we as a society simply cannot afford to pay for $100K procedures on 90 year olds.

Bring out the cry of "death panels", but that's the reality.