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Today's senior citizens in the United States live in the "golden age of aging," receiving more benefits from the government than ever before, far beyond what they reasonably could have expected to receive a generation ago. A large portion of government spending goes to seniors, especially to cover medical care, and Professor Schuck argues that much of this spending is inefficient and, at times, ineffective. In light of the 2008-2009 economic climate and President Obama's push for health care reform, Professor Schuck argues that now is the time to make the hard choices that would lead to more efficient medical care for seniors, even though that may mean rationing of care, an intensely controversial proposition. He argues that the decision on whether to go forward with a medical procedure should be based on the number of quality-adjusted life years (QALYs) derived from the procedure, which is often heavily tied to age.

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