I enjoyed reading this article and I think the choice about how healthcare should be delivered in the U.S. boils down to how we as a society want to spend our (limited) resources. Part of the reason that we spend more in the U.S. than in the E.U. is because in many cases we go to greater lengths to extend someone's life.

I'm not sure that culturally people are willing to accept the idea that we aren't going to do "everything we can" for someone because it isn't worth it to society (the payer). In the case described here, we might have implanted an electronic device to resynchronize the patient's heart and prevent the CHF from trashing the rest of his organs for a few more months (or years) at the cost of $200k.

Are we at a place where people in the U.S. will accept not doing that that?

I think that a single payer with a base level of free care is the right thing for society to do, but the possibility of making private insurance illegal (as it is in some places and some groups in the U.S. are advocating for) is terrifying to me.

The affordable care act basically ensures that we will arrive at a single payer system sooner or later, but how do we change our culture to be more accepting of our own mortality and the limitations placed on extreme measures to extend life?