Several years ago, then vice president candidate Sarah Palin made her famous prediction about Obamacare’s Independent Patient Advisory Board would be akin to “death panels.”

Just a few weeks ago, in a column written for the New York Times, former Obama adviser Steven Rattner wrote, “We need death panels. Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.”

Listen, there’s no way around it. There isn’t enough money available in the healthcare system to continue to keep people alive just because we have the expensive technology to do so. It’s a sad fact that in the last six-12 months of life, the very ill and elderly consume more financial resources than they did in their entire life up to that point.

You may not like what I’m about to say, but it’s going to come down to a decision of do we pay for breast cancer surgery for a 65-year-old working woman who pays income tax and contributes to the cost of Medicare through her withholding, and who is perhaps a vibrant member of the community with a life expectancy of another 20-years, or do we spend those dollars to keep alive a 92-year-old senior with end-stage renal failure, congestive heart failure and dementia, who is bedridden and on Medicaid in her final days in a skilled nursing facility?