The way things are reflects what has been done in the past, and how it has evolved.
When Lyndon Johnson created Medicare, he thought he was solving a problem for a small set of voters, who would be grateful and support the Democrats. He never thought it would grow to $1.5 trillion a year in spending, and be relied on by 60 million people - nearly all of whom vote in every election.
Now what?
Truth be known..... I’m wholly not interested in Medicare and would like to keep my current insurance through the state which is over $800 a month. Alas.... I’m being forced onto this government program whether I like it or not. /:^(
“Now what?”
Split the hospitals up to cut Part A costs.
Split off PPACA drug coverage from PPACA service coverage.
Control drug costs by introducing PPACA drug plans that only need cover 80% of biologic, breakthrough and patented drugs.
As they work better[nearly complete coverage], allow them to be Part D plans too.
Market force competition must be brought to government programs.