End of life care is crazy expensive [1]. Things like assisted living, hospice, and medical care for end of life is where a vast majority of the costs end up. Could the actual care be made more efficient? Maybe. The irony is the GOP spread lies about death panels when the ACA was being debated, and we may end up with them here if we go down a path of deciding who gets what EoL care in the name of efficiency.
you don't. You let people die in a manner according to their own means without blowing through several hundred thousand of public funds on their way out.
If given the choice of 100k EoL care, or 100k for their grandchildren, most people would choose the latter. Add a layer between and it becomes a prisoners dilemma problem. If you forgo treatment, your children still get billed 99.9k instead of 100k.
[1] https://www.thelancet.com/journals/lanam/article/PIIS2667-19...