Elderly Americans are now protected by three major entitlements: Social Security (cash benefits), Medicare (health benefits for all elderly), and Medicaid (additional health benefits for low-income elderly). All are threatened with cuts. Medicaid is further threatened because turning it over to the states eliminates its universal entitlement status. The range of the proposed changes is unprecedented.

This book does not question the need to make cuts. The authors' point is that the whole three-part structure of entitlement should be considered together. Further, looking for cuts first is the wrong way to go. Look for needed improvements in responsiveness and efficiency first, say the authors. Then add up how much these changes would save and decide how these savings should best be used. Pursuing this strategy, the authors identity many changes that are worth serious consideration.