The argument is that Medicare created a compact among generations and made it possible for people to have health care when they are old and need it. And for the most part, it has done its job. Administrative costs are low, and most of the time people get what they need. Like the rest of the health care system, it has been plagued by the high cost of medical treatments and technologies, and it hasn’t been great at controlling those costs largely because it’s politically hard to say no to the pleadings of special interests who want to make sure that their own service, product, or new procedure is covered even if evidence that it works is flimsy.

What do the other candidates say about all this? Earlier this year, the Senate took a vote on an amendment that would have required Medicare beneficiaries with incomes over $160,000 to pay higher premiums for their prescriptions. The amendment was rejected by a vote of 56 to 42. Hillary Clinton and Barack Obama voted against it. McCain didn’t vote.

That vote suggests neither Clinton nor Obama are big supporters of privatization. But neither talk much about Medicare. Voters need to hear more about what they think. What’s needed is a full and open discussion. Does the public want Medicare adequately funded with public revenue, or does it want to shove the increasing costs of care onto beneficiaries, along with their children, who will be saddled with health care expenses when mom and dad can’t pay. If the media doesn’t lead this discussion, who will?

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.