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Editor's Note: Medicare Intentions, Effects, and Politics

To rephrase a lyric by the Grateful Dead, what a short, strange trip it’s been. Just six years ago the combination of the apparent immediate fiscal crisis in the trust fund for Part A of Medicare, anticipation of the Baby Boom’s approaching retirement, and the largely unexpected arrival of active, conservative Republican majorities in Congress shot fundamental restructuring of Medicare to the top of the nation’s political and legislative agendas. That theme carried through the often contentious work of the National Bipartisan Commission on the Future of Medicare, which in 1999 fell just one vote short of the supermajority required to recommend formally shifting from providing a package of defined benefits to giving checks to beneficiaries (“premium support”) toward purchase of their choice of a qualified private health insurance plan in competition with “traditional Medicare.” Many pages of this journal and others, as well as various special edited books, were devoted to assessments of the relative merits of different market-based models for Medicare. However, thanks to a continuing robust economy, the resulting welcome surge in revenues, and the surprisingly effective financial restraints imposed on Medicare provider payments by the bipartisan Balanced Budget Act of 1997, what looked like looming deficits for the health insurance trust fund starting as soon as next year has been pushed back more than two decades, according to the most recent report of the Medicare trustees (Board of Trustees 2000). Indeed, in their battle for the presidency last year, Vice President Albert Gore and Texas governor