One day a week, I eat lunch at a soup and sandwich shop down the street from my local hospital. Physicians, nurses, managers, EMTs and others associated with the hospital frequent the place and often I overhear — OK, eavesdrop on — conversations about their jobs. For somebody keenly interested in the work-a-day world of hospitals, what they have to say can be enlightening.

Recently I overheard — eavesdropped on — a conversation among a group of what looked to me to be 30- and 40-somethings. They were talking about Medicare — not your typical lunchtime chitchat, but not all that surprising considering the heated political debate now taking place and the fact that a lot of their livelihood depends on those government reimbursements. Their conversation, very roughly reproduced here from notes scribbled on napkins and a memory that I'm the first to admit ain't what it used to be, illustrates the conundrum our country faces as we wrestle with the costs of so-called entitlement programs. I've made up all the names.

One of the women —"Julia" — said the United States is the only first-world country whose citizens face potential bankruptcy late in life because of medical bills.

Bob countered that it's not his fault if someone fails to put away enough money during their working years to cover all their retirement costs.

"Are you socking it away?" Julia asked.

"I plan to," he replied.

Dan pointed out that a lot of people who thought they'd adequately saved for the future lost a big chunk of their retirement savings, home values and other investments in the Great Recession.

But it's unfair, Bob argued, to expect him to pay taxes into a program that might not even be there when he retires 30 years down the line.

"We need to save Medicare," Julia said. Others around the table nodded, even Bob.

"Privatize it" was his response.

That got the attention of one of the younger men, who had been engrossed in a meatball sub. He said he'd read somewhere that costs for "a lot of medical stuff" were actually higher under private insurance than under Medicare. To which Bob gave a skeptical chuckle.

"I read that, too," Dan seconded, promising to Google the research and pass it along.

Arlene said the Medicare eligibility age ought to be raised to 70 at least, and that the change ought to be implemented sooner rather than later, even though she knows that in an election year no politician is going to alienate baby boomers just entering or about to enter retirement. And, she added, it's unrealistic to provide the same benefits to every senior; those with more money should pay a higher share of their medical bills out of their own pockets.

Carlos said if health care gets better (by which, I assume he meant quality and efficiency improves), costs will come down. He cited the home visits his department had undertaken to make sure older patients with chronic illnesses followed their doctors' orders. "It's cheaper than having them come back to the hospital over and over again," he said.

Dan said he would rather his parents have adequate Medicare coverage to pay for their own health care. "Otherwise, I'll have to help them out. And that's going to take a lot more out of my wallet than whatever I might have to pay in taxes."

Or, Julia said, they'll have to deplete all their assets and go on Medicaid.

But just that week the state had "gutted" Medicaid, Carlos said, so a lot of people will have to go to the emergency room for all their health care needs.

"That's not good," Arlene said, and everybody nodded in agreement, even Bob.

I'd like to hear your thoughts on the touchy issue of Medicare. Is it viable without changes? If not, what changes would you recommend? Share your thoughts at