It's quite clear from what Obama has been saying that he thinks there is a great deal of unnecessary care, particularly late in peoples' lives, that makes them worse off, or at least, no better off.
It is actually entirely true that if you're focused on cutting costs, you would never install a pacemaker in a 99 year old woman. The number of quality-adjusted-life-years you could expect to get out of that procedure is not high. Meanwhile, she's very likely to die on the table, wasting thousands of dollars and the last days of her life. If Obama is serious about bending the cost curve, he will create some sort of agency that will say no. And it's no good saying, as you do to under-65's, that this rationing will only apply to bonus care for people who currently lack insurance. Cutting costs means taking options away from seniors. You may think that they would be better off without those options. But they clearly don't.