Medical care programs of various types have now moved to the center of the domestic economic stage. Retirees availing themselves of these medical benefits are worried about the future cost, adequacy, and structure of these benefits. The 1996 national elections obfuscated the real issues and have sown widespread confusion. Probably a bipartisan Congressional or differently structured ad hoc commission will be asked to make future recommendations on Medicare (a social insurance program) to the President. Medicaid (a public assistance program) will be dramatically affected by the new welfare reform law and has unique problems of its own. In both Medicare and Medicaid managed care approaches, particularly the further spread of HMOs (health maintenance organizations), can be expected. Political leadership of a type not displayed much in recent Congresses will be needed to allay the worries and mollify the economic security concerns of retirees and senior citizens.