In considering ways to improve Medicare, I'm going to return to a theme I've touched on before: promoting value at all levels of the health system. Recent reforms to Medicare (and Medicaid) have made some progress in this direction, primarily on the payer side, in part by beginning to reward modes of delivery that have already shown themselves to improve quality and cut costs. But there are other ways to pursue value, for instance by putting the impetus on the consumer. Take value-based insurance design (V-BID): Today, MedPAC, the independent group of experts who advise Congress on Medicare, released their June report (they release reports in March and June every year). In the third chapter, they walk through some of the shortcomings of Medicare's current payment structure and raise a topic they've broached before: They don't develop explicit recommendations but rather they walk through some of the implications that will have to be considered and questions that will have to be answered if Medicare does eventually move to incorporate more V-BID (and they rightly point out that several variables will come into play).