technology growth, the desire for one standard of care (everyone gets Lucentis or Avastin, MRIs, ICUs, maximum end of life care), the growth of the population, the
aging of the population, the
cost of "defensive medicine" to combat the sue-happy US cultrure, and the amount of care spent in the last year of life, and the "bureaucratic" costs of dealing with insurance companies, the state and local governments.