I’m terribly sorry that my short (and perhaps careless) answer to the Medicare question angered some of the readers. Let me explain: I carry private insurance because I can afford to and because most of my doctors won’t accept Medicare (a big problem for a lot of people as more and more doctors refuse it because of the small payments). I know I’m lucky but that doesn’t mean I’m callous.

What I tried to say in my answer is that Medicare and Medicaid are currently creating a future tsunami of debt that will be a terrible burden for our children and grandchildren. This is not a matter of opinion but is confirmed by the Congressional Budget Office (a nonpartisan body) and virtually every expert who has studied the situation. What the president is suggesting is expanded health-care coverage (which I ardently support) without any reform of any kind of existing programs, which are major drivers of the deficit. There have been a number of suggested reforms because Medicare, as currently administered, is more costly than it need be. Many thousands – maybe millions – will object to almost any reform that is suggested because such reforms usually mean cutting benefits in one way or another. However, there are some reforms on the table that, while certain might take ten years to implement, would cut costs without denying any necessary service to those in need.

Currently, we have a fee-for-service system, regardless of who orders the service. Sometimes it is the doctor, many of whom practice defensive medicine because of potential lawsuits; other times it’s hospitals and other providers who admittedly order more tests than are necessary for different reasons. All I’m suggesting is that while I’d like to see universal health coverage, I’d also like to see some reforms that would bring health-care costs under control, but every time any suggestion is made, the word "rationing" comes up and that ends the discussion. I am as aware as anyone of the devastation of illness (and death) of a (young) loved one, and so I completely understand the emotions that attend any discussion of these issues. But sooner or later, the debt situation will force painful decisions and I am arguing only that it would be better to begin reform now when the problems are more manageable than it will be in ten more years of piling up this unsustainable debt and trying to arrive at sensible decisions during a major crisis.