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To achieve the same outcome it costs far less than it used to We can treat a lot of stuff (like AIDS) that we couldn't used to. That is an improvement, not an increase in cost.

No. It's an improvement AND an increase in cost. Is it a frivolity to be foregone by a rational self-payer? Only if you don't have cancer (or AIDS) and know for sure you won't get it.

If people are paying, they make more rational choices

Is it rational to choose to die or get really sick because you can't pay for treatment? Is it rational to drive around in a ratty old car because you want your kids to go to a good school? Is it rational to pay for medical treatment for your kids rather than for yourself? Many people face really hard choices.

I know lots of middle class people here in the midwest who have gotten elective surgery. Maybe you guys out in LA are paying too much of your $$$ for housing...

Yes, middle class people get elective surgery too.
No, people in LA are paying market price for their housing.

The ability to treat what was untreatable creates a new product for healthcare consumers and expands the size of the market. If you want to define "cost" as the total bill, then OK. But the fact remains that for any particular outcome it is getting cheaper.

Behavior is going to be affected at the margins. For instance, would you saddle your familiy with millions of debt for one more week of life? You are much more likely to do that to my family!

Actually you point about market prices in LA is 100% correct. And it kinda illustrates my point. My lifestyle would be much enhanced to have your weather, but I am not willing to give up other things in order to get it.

Your notion that healtcare is unaffordable for the middle class is not borne out by reality. Who do you think is paying for it now (including the tab for the poor)?