Dr. Ricard Puumala remembers when Medicare was new, 50 years ago.

"A woman came in and talked to my father, who was a doctor," recalled the Cloquet physician, who retired from his practice last year after 54 years in medicine.

"She said: I don't want any pills, I don't want any shots. All I want is some of that Medicare. That was her take on what the program was."

He paused, with the hint of a chuckle. "But we didn't happen to have any Medicare in stock."

The concept of government-sponsored health insurance for the poor, disabled and aged may have seemed novel when President Lyndon B. Johnson signed the Social Security Amendments into law on July 30, 1965.

Five decades later, Medicare and its twin, Medicaid, are firmly entrenched in American life. One one out of every three of us are covered by at least one of the programs - more than 100 million Americans, according to the Centers for Medicare and Medicaid Services, which administers the program.

Before 1966, according to the agency, roughly half of the nation's senior citizens had no health insurance. Now, almost all Americans 65 and older are covered by Medicare or a combination of Medicare and Medicaid.

Puumala, who is in his 70s, said he appreciates his Medicare coverage, although he pays out of pocket for additional coverage.

But he's dubious about the concept of health insurance in general, he said.

Six months after he joined his father's practice, the paper mill first offered health insurance for its employees, Puumala recalled.

"When I started, office calls were $4," he said. "Then came the insurance schemes and we had to hire more people to help process the paper."

Although he says they have benefited many people, Puumala counts Medicare and Medicaid as among those schemes. The major beneficiaries, he said, have been bureaucrats and administrators, while he and other doctors became mere tools.

"I get the feeling that I'm a clerk now," he said.

But Buddy Robinson of Minnesota Citizens Federation Northeast, argues that Medicare has been an enormous success and should be protected and expanded.

The administrative cost is 1 percent for Medicare, compared with 15 to 20 percent for private plans, Robinson said. That's because the private companies have additional expenses, such as advertising, generating profits, financial reserves and "very high executive compensation," he said.

"There are plenty of sentiments ... that the public sector can't do anything more efficiently than the private sector," Robinson said. "But this is a clear example of just the opposite."

Nick Novak, of the Madison, Wis.-based MacIver Institute, a free-market think tank, disagrees.

"If you truly look at the private market and you truly let the private market regulate itself, you would very quickly see not only health care costs go down dramatically ... but you'd see those administrative costs come down because now the market will be taking over," said Novak, who is the group's communications director.

Spending on the programs - $505 billion of the federal budget going to Medicare in 2014 and nearly $500 billion for Medicaid - can't continue, Novak said.

"Our aging population is making it so there are fewer people paying into these programs and more and more people are taking the benefits, which is simply not sustainable," he said.

Not surprisingly, the two have starkly different views on what should come next.

Robinson argues that Medicare ultimately ought to be expanded to cover everyone. Even the wealthy would be covered, with premiums paid on a sliding scale based on income.

If that sounds like national health insurance, Robinson acknowledges that it is - under a name with which most people feel comfortable.

"Public debate about some form of national health insurance is fraught with huge amounts of misunderstanding and misleading rhetoric, and people can be talking past each other," Robinson said. "Medicare, however, is a known entity; it's very popular. Once people get on it, they're incredibly grateful to have it."

Novak, on the other hand, calls for preserving the programs for those who need it most while offering marketplace options for others, especially the young.

"For those who are right out of college, in their 20s, 30s and even early 40s ... these entitlements are simply not going to be available to them the same way they were for the older generation," he said.

Robinson said he thought Minnesota could lead the way by offering its own version of a broader Medicare program. Under the Affordable Care Act, he noted, states can seek "innovation waivers" beginning in 2017 to try something new in health insurance.

"In Canada, their current system started with one province: Saskatchewan," Robinson said.

Puumala said he thinks eventually the U.S. will have a national health insurance system similar to that in many other industrialized nations.

But he's nostalgic for the pre-insurance days, he said, when doctors got to focus more on patients and less on paperwork.

"When I started practice I was a teacher; I taught my patients how to deal with problems," he said. "There was joy there. Now you just list your symptoms and I put them in an algorithm and this is what you do about it."