In this cross-cutting analysis, some of the nation's most prominent social insurance experts go beyond recent budget debates to examine the fundamental and technical choices Medicare poses for the American people in the next century. The book begins with a consideration of the underlying social contract between Medicare's beneficiaries and workers. Pointing out that Medicare historically has had particular significance for civil rights and women's economic security in addition to providing health security, the authors debate the appropriate social contract for the future. The book also lays out the challenges in financing Medicare as health care costs rise and the population ages. Several authors explore how the growth in managed care is likely to affect Medicare beneficiaries with particular emphasis on beneficiaries with chronic illness, and they address some of the policy changes needed to make managed care better. In addition, they also look at how managed-care tools could be applied to the fee-for-service sector. The book concludes with an examination of how public opinion, politics, and leadership affect the prospects for significant Medicare restructuring in the near and long term. Copublished with the National Academy of Social Insurance