There is no simple answer. Some causes

1) the last 12 months of life, people consume (on an average) more resources than in all of their previous years, though there are plenty of exceptions. i have seen hundreds of thousands expended to add a week to the life of a dying patient.There is no longer an acceptance of death as a part of life. People say "do everything".(2). Lack of personal responsibility-people on Medicaid smoke and then demand expensive respiratory treatments, alcoholics and the morbidly obese go on disability for their self-inflicted disease. They don't pay their own bills.The costs get shifted to those who do. (3). The breakdown of the family, the building block of society: in past generations people took care of their frail or ill relatives. now they demand that the health care system do it . (4). new treatments and meds-horribly costly. BTW, Hillary or Barack won't be participating in what they plan for you.