Recent debates on Medicare reform focus on prescription drug coverage, expanding managed-care choices, or technical issues of payment policy. Despite all the heat generated by these issues, Edward F. Lawlor's new book, Redesigning the Medicare Contract, demonstrates that fundamental questions of purpose and policy design for Medicare have been largely ignored. Challenging conventional ideas, Lawlor suggests that we look at Medicare as a contract between the federal government, the program's beneficiaries, and health care providers. Medicare reform, then, would involve rewriting this contract so that it more successfully serves the interests of both beneficiaries and taxpayers. To do this, Lawlor argues that we must improve the agency of the program—the informational, organizational, and incentive elements that assure Medicare program carries out beneficiary and taxpayer interests in providing the most appropriate, high-quality care possible. The book includes a chapter devoted solely to concepts and applications that give definition to this brand of agency theory. Lawlor's innovative agency approach is matched with lucid explanation of the more comprehensive groundwork in the history and politics of the Medicare program. Lawlor's important and timely book reframes the Medicare debate in a productive manner and effectively analyzes alternatives for reform. Lawlor argues that effective policy design for Medicare requires greater appreciation of the vulnerability of beneficiaries, the complexity of the program itself, its wide geographical variations in services and financing, and the realistic possibilities for government and private sector roles. Tackling difficult problems like end-of-life and high-tech care—and offering sensible solutions—Redesigning the Medicare Contract will interest political scientists, economists, policy analysts, and health care professionals alike.

This book is about health care entitlements in the US-and about the threat of disentitlement. It describes the history and legal character of our Medicare and Medicaid programs, and of the tax subsidies that have brought health insurance to most working Americans. It examines the thread that our entitlements face from privatization, individualism, and devolution. It considers the models that other countries have developed for health care entitlements and what we can learn from them. The book concludes by proposing a redesigned entitlement-based health care system for the future.

Savvy, comprehensive, and authoritative, this book, written by a physician with more than thirty years experience caring for elderly patients, assesses the current state and the future prospects of Medicare, perhaps the most influential health-insurance program of our time. Christine K. Cassel draws upon the latest developments in science and medicine in a sweeping analysis of Medicare s social, demographic, institutional, political, and policy contexts. Writing in accessible language, using case studies to illustrate how policies translate to everyday lives, and applying lessons from the practice of geriatric medicine, Cassel makes a powerful argument for reforming and modernizing Medicare. She offers a new vision of what healthy aging could be and delineates what is needed to realize this vision, including changes in the medical sector, in the policy arena, and in our cultural beliefs about aging. Cassel sheds light on a wide range of issues pertaining to Medicare, including debates about coverage and the looming deficit in the Medicare trust fund. Perhaps the most controversial issue she addresses is the challenge of rationing some kinds of care. Anchoring her discussion of Medicare in the idea that care for the elderly represents a social contract between government and its citizens, Cassel describes both the principles and potential of a progressive approach to geriatric medicine. She further argues that with this approach, we can also address the chronic problems of our larger health-care system and provide all Americans, no matter what their age, with high-quality and affordable medical care.