The title of Dr. Sinclair's paper captures a widely held viewpoint - medicare must change. Since medicare came into being, the consensus surrounding this assertion has never been so great. It is shared by politicians, health policy experts, healthcare professionals and more importantly by the public.

The question that besets all of the foregoing is how to change it. Unfortunately, there are a number of misunderstandings and misconceptions about healthcare expenditures (HCE) that fuel rather than calm the debate. While in agreement with Dr. Sinclair's conclusions that the answer to the question "Can medicare be saved?" is a "resounding yes," some of his operating assumptions and figures quoted would benefit from more discussion.

In his paper, Dr. Sinclair describes a number of problems facing medicare, including: public expectations, escalation of healthcare costs, population aging, rationing, need versus demand, medicare's inefficiency and the erosion of public confidence in medicare. In particular, it is these seven claims that merit closer scrutiny and analysis.


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