Given the fact that Medicare expenditures account for so much of the nation's total healthcare costs, the candidates have been eerily silent on what to do about it.

 

So concludes author Trudy Lieberman in Medicare Mystery, which she wrote for the Columbia Journalism Review.

 

Lieberman tried, largely in vain, to find published statements from candidates about the huge federal program that delivers basic healthcare (and, now, drug coverage) to Americans over 65 and with disabilities.

 

As Lieberman points out, there's plenty to say--and worry about:

 

Sometimes Medicare is cited (often by Democrats) as an example of how the government can provide basic, affordable care to millions of people.

 

But the program is headed toward financial ruin by 2019, it doesn't cover most preventive services or chronic disease management and it currently provides excessive subsidies to private insurers while (doctors say) underpaying rank-and-file physicians.

 

Sometiems Medicare is used (often by Republicans) as an example of an expensive, inefficient experiment in "socialized medicine," the antithesis of the private, free-market-based solutions they propose.

 

But a marketplace of private hospitals, providers, insurers and others has produced the system we now have, which leaves millions uncovered, uninsured for pre-existing conditions and, sometimes, denied essential medical services.

 

The fact is, Medicare covers a majority of health care costs in America.

 

How seriously can people take healthcare proposals that don't mention what to do about it?