Recent policy debates about the future of Social Security and Medicare have been dominated by the issue of personal versus societal responsibility. Significant changes now being considered would increase the level of privatization and tilt these programs away from defined benefit toward defined contribution models.This annual volume of the National Academy of Social Insurance examines the concept of introducing choice into the Social Security and Medicare programs, how it would be defined and structured, and what sort of safeguards would be needed to protect program participants. The ideas, from representatives of the public and private sectors, range from ¡°tinkering¡± to ¡°overhauling¡± the programs to make them more responsive and cost-effective. The contributors provide an overview of the history and fundamental values of social insurance, discuss options for reforming Social Security and Medicare, review the benefits and drawbacks of expanding choice options, explore the types of mechanisms needed to protect consumers if market-based reforms are adopted, and address the political likelihood of Social Security and Medicare reforms. The essays in this volume give parameters to the debate over the future of Social Security and Medicare, and reflect the range and diversity of views which will shape these two hallmark social insurance programs for decades to come.
