ABSTRACT
A quarter century after Medicare’s enactment, the initial expectations of its gradual transformation into a comprehensive national health program did not materialize. The opposite is the case, as the federal government seeks to further curb its fiscal liability in health care. Demographic pressures exacerbate, however the demand for services. Planners responded to this demand with efficiency related strategies, but services remain inadequate and inequitable. The Catastrophic Coverage Amendments were repealed precisely because of their perceived built-in inequitable financing. A new policy agenda will emerge focused on home care alternatives to institutionalization, and long term care initiatives.
