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John Z. Ayanian, MD, MPP

JAMA. 2009;301(6):668-670.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Medicare is a dominant force in the health care system of the United States. When it was launched as a national social insurance program for elderly and disabled Americans in 1965, Medicare was grafted onto the existing health care delivery system. Over the past 40 years, most physicians and hospitals have continued to receive regulated payments from Medicare with no limits on the volume of services provided and minimal oversight or coordination of care. In 2009, Medicare expenditures will exceed $400 billion, representing 13% of the federal budget and about one-fifth of all US expenditures on health care.¹

This status quo, however, is not sustainable for Medicare. Last year, the Medicare trustees projected that the Hospital Insurance Trust Fund will be exhausted in 2019 without new measures to increase payroll taxes or contain the growth of expenditures.¹ In response to similar concerns during the past . . . [Full Text of this Article]

Author Affiliations: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Health Care Policy, Harvard Medical School; and Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.

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