Fact and fiction: The medicare "crisis" seen from the United States

There are at present two conflicting images of medicare available to the visitor from the United States. One is the conventional media portrait of crisis--from both U.S. and Canadian sources--an image of a program in deep trouble, overcome by problems of access, cost and quality. The other image is far more favourable: medicare as a structurally sound program of universal health insurance that largely satisfies those who use it, but, like all programs, requires managerial adjustment and attention to the fearfulness of medicare's future that has marked the last decade. This is the conclusion of the recent report of the Canadian Institute for Health Information (CIHI). Both portraits cannot be accurate, just as being green and white all over is logically impossible. What is the American interpreter to make of this dispute?