Advocates of single-payer health care have often oversimplified the issue and suggested that we should "just make Medicare available to everyone."  Bad idea.  Medicare is basically an honor system.  Even Wikipedia states this in its definition of Medicare fraud:

The Medicare program is a target for fraud because it is based on the "honor system" of billing. It was originally set-up to help honest doctors who helped the needy with medical services.

If I claim to have sent wheelchairs to five people because that is my business at 123 ABC street, then I will get a check in the mail.  All I have to do is show an invoice in the form they expect, and I am doing nothing but going to the bank and making withdrawals.

This has been known for a long time.  Medicare needs cleaning up just to stay where it is, let alone expand it to more recipients.  Are we cleaning this up?  Apart from the occasional flashy indictment, there is no sustained effort.

I wish I had a contract with the federal government to be paid one half of one percent of what I could save for them if I found instances of fraud.  The first thing I would do is go on Google Earth and see if the addresses of vendors existed, or if they were empty lots.  Next I would cross-check addresses and see if checks were being sent to different vendors at the same addresses.  Then I would just phone a few people -- "Excuse me, Mrs. Smith, did you get a wheelchair from Whatzis Enterprises?"  Even with cursory spot-checking, I would be in the chips before the day was out.

Clearly, expanding Medicare down to younger recipients is not the answer, but our government has a different idea: bring Medicaid up.  Medicaid is welfare insurance, and it stinks.  Doctors are paid less to provide the same services as they otherwise do.  As this is a democracy and doctors get to say no, many won't take Medicaid patients.

The worst thing to do is to "expand Medicaid."  The government offered a sweetener to states to subsidize part of the new Medicaid load for a while if they expanded the program to cover people whose income is four times the poverty level rather than one time the poverty level.  The feds are nudging us toward thinking of Medicaid as "Medicare for the young."

Talk about your Trojan horses.

Many states were already frantically cutting Medicaid benefits to save money, making it even more unattractive to providers.  The following list points out a few of the things that were done this summer.

-Illinois cut enrollees to four prescriptions a month; imposed a copay for prescriptions for non-pregnant adults; raised eligibility to eliminate more than 25,000 adults and eliminated non-emergency dental care for adults.

-Alabama cut pay for doctors and dentists 10 percent and eliminated coverage for eyeglasses.

-Florida cut funding to hospitals that treat Medicaid patients by 5.6 percent - following a 12.5 percent cut a year ago. The state is also seeking permission to limit non-pregnant adults to two primary care visits a month unless they are pregnant, and to cap emergency room coverage at six visits a year.

-California added a $15 fee for those who go to the emergency room for routine care and cut reimbursements to private hospitals by $150 million.

-Wisconsin added or increased monthly premiums for most non-pregnant adults with incomes above $14,856 for an individual.

The first thing the ObamaCare website does is check if you qualify for Medicaid.  If you do, you get a message saying, "Congratulations: you have been enrolled in Medicaid."  Then you have no premiums -- just free health insurance.  If you do not want welfare health care, too bad.  It is unclear whether a mechanism for getting off the program even exists.

This is a slam-dunk for the administration.  No subsidies, no dealing with testy carriers -- just push as many applicants as possible back onto the states.  Later, just pull the subsidies and call it a cost-saving, deficit-reducing brilliant idea.

Consequently, many states are reeling under the prospect of this deluge of Medicaid enrollees; just paying their share is swamping many of them, subsidy notwithstanding.  Colorado is considering which state benefits it will have to roll back to pay for this new batch of dependents.

Our government was well aware that this would happen.  So what next?  What happens when these new sign-ups find out that there are no doctors in their communities who take Medicaid patients?  That they have to drive to a doctor a long way away and wait for hours for service?  That they can't go to a hospital down the block, but must drive 50 miles to another hospital?

I can see the heart-wrenching anecdotes now.  "Poor Harold's daughter died in his arms as they drove by their local hospital, headed for one that is far away.  How does that make you feel, Harold?"

Our government and its lapdog media will hungrily snatch up these anecdotes and stuff them down our throats.  They envision a scenario where the people rise up, demanding, "How dare they?" and railing for something to be done -- namely, to force doctors to take these patients, then bloat the program even more by expanding the services provided under this once-limited plan.

"You mean I can't get a CAT scan because I'm poor?"
"Shouldn't a single mother get therapy in her home?"
"Is my life worth less because I am poor?"

See where we are headed?  Medicaid, not Medicare, is the vehicle to single payer.