Why do our elected representatives submit proposals that do not discuss ways to make Medicare work — and flourish? Why does the Paul Ryan plan, for example, pull apart the most successful health care program in the nation’s history and piece it out to the private market, through vouchers and other means? Why are taxpayers the ones who are told that they will have to make additional “hard choices,” when they need proposals to address the hard choices they’ve had to make between buying medicines or paying rent?

There are so many more options available to us to save Medicare money than the cut-and-bleed approach endorsed by many of these political leaders.

Congress could allow more people to buy into the Medicare program. Taxpayers would benefit from allowing additional individuals to buy into the Medicare program. Currently, non-disabled individuals between the ages of 55 and 65 cannot buy into the Medicare program. If they were allowed to do so, their premiums would help support the costs of the less healthy, as well as providing the new enrollees with less costly preventive and primary care.

Let the Affordable Care Act do its job. The Affordable Care Act included Medicare-altering provisions. These included creation of an active Medicare review panel charged with the task of ensuring that services are not diminished while keeping costs within a reasonable range. The act funds pilot projects intended to guide the development of Medicare ‘’best practices,’’ and it encourages the development of quality in-home, local long-term care. More generally, the law bans pre-existing condition exclusions and rescission of policies on immaterial grounds, which saved companies money while stranding critically and chronically ill patients who need an insurance system capable of providing the coverage it’s paid to provide.

Bring ‘dual eligibles’ back into the less expensive Medicaid system. Another major piece of legislation accomplished the opposite of what the Affordable Care Act is structured to do, by pushing many Medicare drug beneficiaries into the more expensive private market. The Medicare Modernization Act (MMA), which created Medicare Part D, actually pulled beneficiaries out of the Medicaid program — where their prescriptions were significantly cheaper — and required that they participate in the new Medicare program. Treatment for these beneficiaries — called “dual eligibles” — could be provided for $30 billion less over 10 years, according to the CBO, if they were once again allowed to benefit from the Medicaid drug rebates.

Negotiate prices with pharmaceutical companies. This same piece of legislation enacted a market protection measure that causes taxpayers to pay 70 percent more for prescription drugs in the Medicare program than through the Department of Veterans Affairs. Congress ensured that pharmaceutical companies would not be forced to negotiate prices with the secretary of Health and Human Services in Medicare, costing their constituents an amount estimated near the $200 billion mark over 10 years. Congress should be told to rectify this huge and costly concession to pharmaceutical companies.

Stop overpaying Medicare Advantage Plans. These plans cost taxpayers 10 percent more per beneficiary that traditional Medicare. Claims that the services provided require the enhanced payments do not hold up in light of a recent study showing that a large portion of that 10 percent goes to insurers rather than benefiting Medicare beneficiaries. These beneficiaries often find themselves paying significantly higher cost-sharing amounts than they would under traditional Medicare, while private insurers receive bonuses and other extra payments for providing the same coverage as traditional Medicare.

So why don’t our elected representatives discuss these proposals instead of telling us we have to make “hard choices”?

One congressman has tipped his hand by proposing a piece of reactive legislation meant to protect insurance agents from diminished profits under the Affordable Care Act. It proposes to “fix” the law by allowing companies to pay a higher percentage of insurance premiums for administration expenses than for actual care — in order to protect the salaries of insurance company employees.

The justification provided for the bill is that the insurance company employee attempting to sell policies to your mother and father is actually their most reliable means of being educated about insurance. Therefore, industry profits, coming from the pockets of you and me, should be protected.

This kind of hogwash shows us just how comfortable we’ve become promoting the free market beyond rationality. Its arguments and rationalizations are used to challenge the Affordable Care Act and keep in place the least successful health care system among all industrialized countries in the world.

If all that your elected representative tells you is that you’ve got “hard choices,” that’s simply an indication he’s not looking hard enough at real fixes.

Robert W. Bush is a public interest attorney living in Savannah who has worked on health care issues for many years.