I love the ideas that Sam Altman has but would say that reigning in Medicare/Medicaid fraud would truly need to be tackled aggressively before expanding Medicare. You need to look no further than the $1.3 billion Medicare fraud that was reported today.<p>One area that seriously needs addressing with regards to healthcare that nobody thinks about are the family member caregivers who cannot work outside of the home because their are no resources to care for their disabled family members. In these situations the disabled family members have Medicare (after 27 months from disability date) but the caregiver who cannot work outside of the home because they have to provide care for their loved ones are currently not eligible for Medicare until they reach 65. These families are typically financially strapped already due to the uncovered cost of healthcare for their loved ones. Add that to then not being able to work outside of the home because they must care for their loved one and you are dealing with typically very low income families. When a family member is the primary caregiver of an individual with disabilities they should be able to get on Medicare as well regardless of age. This would go a long way to dealing with caregiver depression and would allow thousands of individuals to stay in their homes rather than being placed in institutions or community based services because one family member cannot stay home and provide care because they must work to purchase their own health insurance.