The estimable Duncan Sinclair has called for a rethinking of medicare. Who can disagree? It is the rare program that cannot benefit from rethinking, and Dr. Sinclair makes many cogent points. Nonetheless, the devil is in the details, and I am unconvinced that many of these reforms are addressed at the parts of medicare which are now broken. I am unconvinced by his basic premise that "the status quo is not sustainable," particularly as this relates to maintaining public financing for medically necessary care. As a policy analyst, I teach my students to beware the TINA (There Is No Alternative) argument - it usually camouflages underlying assumptions, which are often debatable, and sometimes incorrect. Given length restrictions, this paper will therefore address some of our areas of disagreement, recognizing that insufficient attention to our many points of agreement will be an inevitable consequence.

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