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Book and Media Reviews
April 26, 2006

Medicare

Author Affiliations
 

Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA.

JAMA. 2006;295(16):1947-1952. doi:10.1001/jama.295.16.1950

In Shredding the Social Contract, John Geyman examines the development of the largest social insurance program in the country—Medicare—identifies the multitude of influences that have led to the current state of the Medicare program, and suggests that national health insurance (NHI) may be the only solution to its problems.

In an investigative reporting style with generous use of quotations from policy makers, physicians, institutional providers, and beneficiaries, Geyman makes the case that Medicare's problems pose challenges to a broad array of stakeholders. He cites research demonstrating Medicare's impact on the federal budget and the financial health of practitioners and institutional providers; brings in information from media accounts, public documents, and scholarly journals; and offers personal accounts from beneficiaries to illustrate the obstacles that stem from hastily implementing new programs or reinterpreting existing ones. After reading these accounts, the reader comes away convinced that “fixing” Medicare will not be easy given the political, social, and economic forces molding the program's future.

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