Medicare is the most successful government social program in U.S. history. It not only provides access to care for 45.3 million people older than 65 and 8.8 million disabled people, but by doing so keeps millions of those people out of the crushing poverty that otherwise would result from serious health problems.

So the practical question is not whether Medicare should continue, but how.

Because the program is tied to health care inflation, its costs have risen faster than the rate of general inflation since the beginning of the program. In 2013, according to the new annual report by Medicare's trustees, the program spent $583 billion.

But the report, while calling for some reforms, contains significant good news about the program's performance and future. The rate of Medicare spending has slowed substantially, due to a host of factors, to the point that this year's report projects the potential insolvency date of its trust fund at 2030, four years later than last year's projection.

The new federal health care law clearly has had a positive impact on Medicare, which is affected by 165 Obamacare provisions regarding spending and revenue. Other factors include a gradually improving general economy, economic pressure for efficiency through the health care system and a major social trend - newly eligible 65-year-olds generally are healthier than their predecessors at that age, consuming fewer benefits per person. That has helped to drive down average Medicare spending per person by about $1,000.

In all, the report demonstrates that the program should be addressed with a scalpel rather than a hatchet.