Policymakers are considering whether and how to reform Medicare. The “Baby Boom” generation is quickly approaching retirement, and there is a strong desire to add a prescription drug benefit to Medicare. Both these events put increasing pressure on the Medicare program to be as cost efficient as possible. As part of the Medicare reform debate, a question has arisen regarding Medicare’s ability to control costs. Does Medicare have a competitive track record compared to other public and private insurers? How well has Medicare controlled the sometimes explosive growth in health care costs? This report compares the growth rate of Medicare spending with that of a number of other major public and private health insurers over the last two decades.