> the cost of medicare.. is basically a combination of demographics and the cost of medical care, with the cost of medical care being the driving factor. Doesn't that sound like an arena ripe for disruption by startups?

Honestly, not particularly to me. As far as I can tell, this is a largely social issue. The idea that we might not give the best care possible to someone, that we might let someone die when we could keep them alive, that we might put a dollar figure on a person's life is an anathema to many people. I'm not really sure how a startup is going to disrupt that.