Working from theory to practice, Thomas W. Grannemann and Mark V. Pauly develop an approach to Medicaid policy based on a keen understanding of the forces that have shaped the program. They begin by examining the program's intellectual foundations—American altruism and the principles of equity, efficiency, and democracy. They then ask the question: What are the inherent strengths and weakness of the American approach to financing medical care for the poor? The answers it turns out have direct implications for how best to approach implementing health reforms that would extend eligibility, control costs, and provide better value both to program recipients and to taxpayers.