US Healthcare costs and end of life care

http://www.fivethirtyeight.com/2009/12/new-identity-politics-party.html

Forget Tom Schaller's typical partisan and cynical take on the issue (he's the most partisan and least honest contributor to 538).

Do we really need end of life rationing of care? Is it really inevitable anyway and we might as well do it BEFORE it bankrupts us?

Or, is all the waste in the system a product of the fact that virtually all of these costs are paid for by socialized medicine (Medicare and Medicaid)? Would people demand less useless care if they had to pay for it?

Or is it a combination of both?