If your concern is cost basis, and "allocating health spending well", then why are we subsidizing preventative care?
You yourself admit that end of life care is incredibly expensive. Why are we pushing people to live longer, when it incurs a much much greater cost to keep people alive? Why not just let them die young?
In part, this is a huge reason (the other reason is pregnancy cost) why pre-ACA healthcare prices were much much cheaper for <30 men than women - most things that seriously hurt men under 30 just completely off them, and dead boys don't incur major medical cost.
I think most people disagree with you darwinian notions of societal priorities. And you still aren't addressing that pre-ACA we still spent the same dollars, just on the backend through emergency room spending, and medical debt defaults. Basically all research points to outcome focused medicine and preventive care being critical to controlling costs, anything else just shifts the spend around.
I don't believe in those 'darwinian' notion of societal priorities, I'm just pointing out that those are baked into your priorities. If reducing cost is the priority, the machine (government/society) will churn out a solution that reflects the priorities it is programmed with.
I don't know about your characterization that "Basically all research..."
Furthermore, there's an enormous information asymmetry in healthcare, so it's hard for it to function as a market.
Because we already have "free" healthcare in the form of emergency rooms, this is ultimately a conversation about how to best allocate health spending. Emergency care is the absolute most expensive form of non end of life care, so we should focus on minimizing that send. There's a well known path for doing so, regular check ups, vaccinations, preventative care, and chronic disease management. All of which cost money now, but reduce future expenditure. And if we already pay for sick broke people in the emergency room, why not optimize the expenditure of those tax dollars by shifting it to more effective health interventions?