ABSTRACT
Medicare has as many lives as a cat. Every time the latest projection shows it running out of money, Congress does something to save it for a few years more. Medicare and Medicaid passed Congress together in 1965, but their paths were politically quite different. Medicare, a universal program for persons age 65 or more, regardless of income, is the residue of abortive efforts over many years to pass universal health insurance. Medicare payments for services are based on "allowed charges", which once meant "usual, customary, and reasonable". A significant portion of greater intensity results from the rapid diffusion of newly developed technologies and procedures - often before their value has been proven. The government has issued a blank check for the Medicare entitlement, not bound by specific annual appropriations, to cover all needed care within the Medicare policy framework.
