There can be no fruitful political discussion with people who are insincere or hiding their views

[Recursion]

45. Huh? A lot of us support both expansion and shrinkage of Medicare and Medicaid

I'd like them both to cover a lot more people, and to spend a lot less money for the treatments they cover, particularly as regards drugs and devices. The reason the ACA was necessary in 2010 and not some later date is because, unlike SS, Medicare actually is facing actuarial problems and won't be able to self-fund for much longer (ACA has extended this somewhat). Despite being more efficient than private insurers (though even this hides the inefficiencies of the provisioning private insurers -- the "2%" just counts the overhead of handing over money to BCBS, Cygnus, etc. who then provision and take their own overhead), Medicare and Medicaid still pay orders of magnitude more for the same treatments than other countries' insurance systems (be they public or private) do, and that needs to be fixed. We need a much smaller Medicare and Medicaid in dollar terms that provides much more in service terms. However, the reaction on DU to those of us who point this out is often that we're insincere in our desire to preserve Medicare because we want its size as part of the economy to go down.