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This chapter turns to the Medicare insurance system, whose reimbursement policies and decisions convert best evidence into available treatments—the second transformation in the chain of health care drivers. Medicare reimbursement decisions organize the next two transformations in the chain as well. Once a therapy is eligible for reimbursement, it almost instantly undergoes the third transformation and becomes standard for everyone; then, in the fourth transformative move, it becomes necessary. Reimbursement legitimates which interventions should be employed to treat which conditions. Medicare policies are instrumental to the ways seniors experience old age and dying and everyone else experiences what to need, want, and expect from medicine.

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