Book excerpt: Dr. Kissick was an active participant in the drafting of Medicare legislation in the 1960s and for the past twenty-five years has held joint positions in a medical school and a business school where he has specialized in healthcare management. Drawing on his long experience in the field, he discusses the dimensions of the current crisis, the financial and medical implications of alternative proposals-- including the program put forth by the Clinton administration--and the requirements for long-term strategies.