The US spends more on its public health programs (medicare, medicaid, veterans) than most developed countries spend on ALL healthcare (as a % of GDP).

We know Medicare is underfunded and unsustainable. So.....Obama's best idea is to put more people onto Medicare? How can anyone take this seriously?

Obama- fix Medicare first. Show us your ideas for rationing and reform and sustainable long-term funding. Since Medicare/Medicaid is already more expensive than many countries TOTAL spending, the savings you generate from Medicare reform should easily pay for covering the uninsured and maybe even for subsidizing insurance for those of us not in Medicare.

I know you are a political genius (hence your proposal for the Dems to ram through giveaways and freebies in healthcare while kindly inviting the Republicans to take equal responsibility on a bipartisan panel to actually pay for Medicare- i.e. take the blame for fixing up your mess. Nice). However, I have yet to see any evidence that you and your cabinet, your record breaking number of "czars" and the largest, most expensive white house staff in history are policy geniuses.

I'm waiting. Fix our current medicare first and THEN invite more people into it. Thanks

Medicare is a payer, not a provider. How would you suggest anyone "fix" Medicare without reforming the system that delivers the care it pays for?

Your comment doesn't make any sense in relation to the first post. Medicare is the defining player in medical care in this country. All private insurance companies derive license for bad behavior based on the delusions of the Medicare system. Medicare is moving us toward the indentured provider system that has devastated care in Russia and the former Soviet bloc countries, including Cuba. These countries face a severe shortage of competent physicians because they have all immigrated to the West.

"Your comment doesn't make any sense"

But your blather about Cuba and the rest of the bloc is on point?

OK.

Have you ever heard of an HMO or a PPO?- payers organize systems of care all the time. Just because Medicare (and apparently, you) are caught in a 1960s time warp doesn't mean things have to stay that way.

Even as a payer (and Medicare is much more than a disinterested payer- ask any Doctor or hospital), Medicare could decide not to pay for certain procedures for certain people or decide only to provide them at regional or international centers for "excellence" (sorry I have to put that word in quotes when I'm talking about government) that get massive number of patients in return for massive price cuts. Medicare's current system fragments care as the elderly can choose local specialists that are often not as skilled nor as cheap as higher volume providers. Payers have power (again, ask any Doctor or Hospital head).

So yes, Medicare can be reformed and it must be reformed. I have seen what Obama has done to banks and car companies and I want no part of stealth, black box reform, where, say, everyone gets onboard Medicare and then Obama says, "whoops, sorry everything must change". It is already obvious that putting everyone on Medicare won't work. In fact, we know that Medicare as it currently stands is insolvent.

Reforming the existing Medicare and Medicaid systems would be the ideal way for Obama to experiment with his ideas. And I want to see his ideas in action on a fairly large scale before he starts thinking he can control and micromanage the nation's healthcare system.

"Have you ever heard of an HMO or a PPO?- payers organize systems of care all the time. Just because Medicare (and apparently, you) are caught in a 1960s time warp doesn't mean things have to stay that way."

Poor, stupid me.

Thanks just eversomuch.

The problem with Medicare is we took the most expensive and highest risk folks and put them into a single pool. Since the annual cost of caring for an 85 year old is about $18,000 as opposed to the average of $500 for a five year old (if my senior mind serves me well), then there is simply no way to spread the financial risk. As a primary care doc, I would be just as happy to have a single payer system (Medicare for all) and be done with it. We can't fund the system is its present form and Medicare really is too big to fail. So we have to adjust the risk pool. Then we can all have a healthy debate about who deserves what piece of the pie.