flounder on problem structuring and definition. Health care absorbs 18% of GDP, and Medicare is the fastest growing program liability at the state level Economists apply the usual concepts of perverse incentives; fragmented rent-seeking institutions; and a free-rider system of payments,with cost-shifting and monopoly, to a sector dominated by lobbies for doctors, insurers, and pharmaceutical companies (Goldhill 2009). Because of the problem's apparent complexity, few agree on the applicability of the various concepts and international models. Even fewer agree on best available solutions. This back of consensus binders the development of the mix of market and regulatory solutions needed to control costs and expand coverage. Despite hard facts on the costs of current health care programs (e.g., Medicare and Medicaid), there is less certainty about the cost of expanding benefits to about 40 million people who are not covered by health care insurance. Based on the inability to control costs in the past (Rushefsky 2008, 187-89), major doubt also exists on how to control program costs in the future. The effort to restructure health care involves factors such as the uncertainties of regulation, managed care organizational behavior, and the effects of privatization options on health care costs and service cover age. The outcomes of various solutions to these subproblems are less predictable, making the overall social insurance problem moderately well structured