"The citizenry insist and insist and insist that they are proud of the Medicare system and that they want it to work. They continually send instructions to this effect to their governments. They do so in every imaginable way. And yet, day by day, the governments and the bureaucracies chip away at the system as if in the hope that, by opening holes in it and creating a new ineffectiveness, the citizenry will drop their commitment to it."