Politically the issue is simple because they voters all want the same thing -- more care at less cost. Most politicians know (a) that's a logical impossibility and (b) that telling voters they can't get want isn't a good electoral strategy. The result is political theater. Candidates must promise the moon to get elected. Those in power must figure out who will get less or pay more. Candidates don't win power by acting like they already have it. That may be frustrating for those in blogdom, but equally constricting for candidates who know that the truth shall make you an also-ran.