Medicare reform and the American devolution

The Medicare Modernization Act of 2003 (MMA'03) did more than introduce a prescription drug benefit for Medicare beneficiaries; it also laid the groundwork for several far-reaching changes in the Medicare program. These changes must be considered in the context of the "American devolution"--a much larger shift in American health and social policy that is changing how Americans manage their health and wealth as more tasks and responsibilities devolve to individuals in managing their personal affairs and their lives in the workplace. The devolution presents a special challenge to those who have diminished capacities for self-direction, including many stroke survivors who are especially dependent on the Medicare program for their rehabilitation and management of their diminished health status. This article calls for a massive investment in information technology and brokerage that will enable all Americans to effectively navigate the brave new world that the changes in the Medicare program portend.