The 1997 Medicare reforms were among the most important social and hea
lth policy legislation of the past three decades. The legislation was
notable in reestablishing a viable health policy process; in disprovin
g predictions that government-run insurance would restrict consumer fr
eedoms more than employer-based health insurance; and in ratifying mar
ket-oriented approaches as a national health paradigm. Most important,
the legislation achieved a historic philosophical compromise between
advocates of govenment health insurance and advocates of private healt
h insurance. The political agreements came at the expense of greater r
egulatory capture of the Medicare program by health provider and healt
h plan interests and at the expense of deficient consumer protections.