Everyone agrees on the need to reform Medicare but not on how to do it. Some argue the program is too comprehensive others that it is not comprehensive enough. Some suggest it pays too much for health care others too little. Meanwhile the financial stakes continue to mount. Medicare spending exceeded 400 billion in 2007 making it more expensive than the entire health systems of most other nations as well as the largest national public program other than Social Security and national defense. In R eforming Medicare Henry J. Aaron and Jeanne M. Lambrew deftly guide readers through this complex debate. They identify and analyze the three leading approaches to reform. Updated social insurance would retain the current system while rationalizing coverage and reducing bureaucracy. Premium support would replace the current system with a capped perperson payment that beneficiaries could use to buy health insurance. Consumerdirected Medicare would have beneficiaries pay for care up to a high deductible from government supported savings accounts and offer premiumsupport coverage above the deductible. In addition to rating each option on its ability to promote access to health care improve the quality of care and control costs the authors evaluate each reformampaposs political strengths and weaknesses. Given the heat generated by the Medicare debate it is unlikely that any single approach will be implemented in full. Consequently Aaron and Lambrew describe incremental strategies that blend elements of each plan. Their analysis provides essential insight into the types of hybrid policies that Congress will consider in coming years.