Entitlements are really for the rich
The obvious way to reduce Medicare costs is to get the predatory insurance companies out of the equation and go to government single-payer. The insurance bureaucracy serves only to siphon money to their CEOs and shareholders. Their primary goal is to make money.
Next, permit Medicare to purchase drugs in the same manner as the Veterans Affairs with volume pricing. Of course, that won't happen because there's too much money changing hands between the various players in the "health" industry, big pharma et al. and our elected representatives. Wall Street stands on the sidelines tossing money at the effort to funnel this cash flow to them through vouchers and more layers of insurance.
The current use of the term "entitlement" is incorrect. American workers pay for Social Security and Medicare through their payroll taxes. "Entitlements" are what the rich individuals and corporations receive via a tax code that permits them to suck the life blood out of our economy. Our tax code, quite obviously, favors capital over labor. Capital wants to receive all the benefits of U.S. citizenship without making any of the sacrifices that entails.
We will be fortunate if our representative democracy survives the Supreme Court's Citizens United ruling that tilts the already skewed playing field even more in favor of big money interests.