Are we prepared to meet current challenge of caring for an aging population? The current national conversation suggests that we are not, that we are not training geriatricians in sufficient numbers to meet needs of aging postwar generation, and that quality of care we now provide to elderly patients could be greatly improved (Zingmond, Wilber, MacLean, & Wenger, 2007). In fact, history of aging in America prompts this question: Has our nation ever been willing to provide goodquality care for elderly? During first two centuries of European settlement in America, older persons accounted for less than 2% of population (Fleming, Evans, & Chutka, 2003). Survival beyond seventh decade remained rare into late 19th century, reflected in only modest growth of their numbers. The pace of industrialization during this period led to a new social order that included a new concept of age. Ironically, while well-being of elderly improved through industrialization and technological expansion and their numbers increased, view of old age as a period of obsolescence or even ill health gained currency as age-based education, employment, retirement, and social welfare became norm. Longevity and comfort in old age have been historically experience of wealthy. Failure to save sufficiently for retirement, let alone for catastrophic care, is not an invention of a profligate babyboomer generation. By eve of World War II, vast majority of elderly lived in poverty, and medical costs had become a significant source of dependency in old age. Certainly, Depression had a profound influence on extent of poverty among aging, but provision for support and care in later life had always been viewed as an individual rather than a societal responsibility. The commonly held view equated failure of breadwinners to provide for themselves and their families with moral or character failure. Whether led by Tom Paine, Theodore Roosevelt, Franklin Roosevelt, or trade union movement, efforts to provide assurnce of health care in old age have succumbed to opposition from disparate political and professional interest groups. MEDICARE AND MEDICAID Before passage of Older Americans Act ( Congressional Record, 1965), which mandated Medicare and Medicaid more than 40 years ago, burden of care for elderly lay on their own shoulders and on hospitals and other providers that assumed care. Since then, Medicare has become a $200-billion-per-year enterprise and remains at center of an enduring political struggle in United States over redistribution of wealth (Vladeck, 1999). Federally financed old-age health insurance became politically viable in 1960s in part because of a growing elderly population with mounting political impact. Despite highly publicized aging of America and projections of lax preparation for coming crisis, the debate increasingly consists of high-sounding arguments cloaking relatively narrow, traditional regional and local issues ( Vladeck, 1999, p. 34). The repercussions of decisions made by state and federal governments affect well-being of Medicare beneficiaries and in fact entire architecture of health care system. Politics at local, state, and federal levels plays a major role in process of dividing and distributing a very large pie. Lobbyists from all corners of medical-industrial complex advocate vigorously for their particular stakeholders. There is little question that programs have dramatically improved health status of older and indigent Americans, but with progress has come a big dose of scandal, greed, and corruption that has done little to promote appeal of an expansion of benefits among key political constituencies. Clinicians generally accept that a thorough understanding of patient's history is essential to process of developing a differential diagnosis and achieving best outcome for patients. …