Financial ruin or financing catastrophic health coverage: who pays?

Concern about financial ruin due to catastrophic illness has precipitated public policy actions resulting in the single largest expansion of the Medicare program by Congress since the program's inception. Using Kingdon's framework, significant participants and their actions are examined in the establishment of the health agenda and the selection of alternatives/solutions during development and passage of this legislation. During the final stages, decisions were largely driven by economics and politics, leaving many elderly persons confused and angered while many other more needy Americans are still at risk for financial ruin due to catastrophic illness.