As in so many cases, the self-styled hardheaded realists are nothing but phony blowhards who start with the desired answer (cut taxes and regulation, privatize, etc.) and reason backwards to their desired policy prescriptions (cut taxes, privatize, etc.)
The real reason conservatives want to do away with Medicare has always been political: It's the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program's defenders against liberals and their death panels.
"Let's live on the planet as if we intend to stay."
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