Medicare at Middle Age: Adapting a Fundamentally Good System

type="main" xml:lang="en"> Strong on addressing financial barriers to access to hospitals and, to a lesser extent, medical services, Medicare has retained residual financial barriers to access, with significant out-of-pocket costs for some, and has not adapted well to the challenges of the twenty-first century. Despite claims to the contrary, Medicare is not unsustainable. However, Medicare's payment arrangements for primary health care, particularly for care for people with chronic illnesses, need to be redesigned. The adaptive efficiency of the health system, including Medicare, needs to be strengthened, possibly through creation of more independent determinative bodies.