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..."
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.