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	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Medicare's projected spending growth is unsustainable. The program already strains the resources of beneficiaries and taxpayers alike and will someday crowd out other public- and private-sector priorities, given that Medicare spending as a percentage of the gross domestic product is expected to nearly double in the next 20 years. At the same time, neither beneficiaries nor taxpayers are getting good value from the program. Per-beneficiary spending in high-spending regions of the country exceeds that in low-spending regions by one third, and yet beneficiaries in high-spending regions receive no better quality of care.¹ The incentives inherent in the dominant fee-for-service payment . . . [Full Text of this Article]

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Mr. Hackbarth is chair, Dr. Reischauer vice-chair, and Ms. Mutti a senior analyst at MedPAC, and Dr. Reischauer is president of the Urban Institute — both in Washington, DC.

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