Medicare was defrauded out of an estimated $47 billion in the last fiscal year. Roll that number around in your head. It's almost enough money to bail out another too-big-to-fail financial institution. It does provide empirical evidence that a government-run, public-option health insurance scheme will not be effective in controlling rising health care costs..

It's a matter of size, and a matter of will. And it's a matter of the right role for government in the marketplace.

As to the bigness of Medicare: 4.4 million claims are processed each day, and they must be paid between 14 and 30 days. It stretches the credibility of the idea of thorough review.

And then there's the will. When the Medicare prescription drug program was set up, the feds hired private companies to investigate complaints and fraudulent claims. Except it took Medicare years to provide the basic information to do this work. That suggests a lack of will. Then there are reports that Medicare officials repeatedly ignored warnings of fraud from its own, internal investigators. Taking care of taxpayer money does not appear to be very high on the priority list of the Centers for Medicare and Medicaid Services.

Talk about the good intentions of reformers all that you want, the track record shown here defies the concept of good government.

Medicare does offer basic information about fraud, and its Web site uses the following examples:

-- Billing Medicare or another insurer for services or items a person has never received.

-- Billing Medicare for services or equipment which are different from what was received.

-- Using another person's Medicare card to get care, supplies or equipment.

--Billing Medicare for home medical equipment after it has been returned.

Then there's that whole business of fake clinics, bogus pharmacies and padded bills. Small potatoes stuff that adds up to $47 billion. The total Medicare budget runs $440 billion, so we're talking about nearly 8 percent going to fraud, although critics put that number at more than 12 percent.

Repeatedly over the past year, when opponents criticized the health care reforms for being too much government involvement in the health insurance and care markets, Medicare has been cited as a government-run, health-care option that works. Yes, Medicare delivers and there are a large number of people that depend upon it and are happy with it. But that ignores the fraud. Medicare only really works if you do not care how much it costs or how much money it wastes.

Believing that fraud can be squeezed out of Medicare and Medicaid -- at least by the present bureaucracy -- to pay for health care reform is wishful thinking at best.