[영문]Through the lens of political and moral economy, I examinedthe dominant values and actors in the legislative process of theMedicare Modernization Act of 2003. In my content analysis offederal hearings, I found that witnesses from government agencies,Congress and think tanks had almost equal presence at thehearings. Witnesses who were invited by Congress to testify atthe hearings expressed twice as much support for private intereststhan for the general Medicare population or low-income beneficiaries. Few expressed concern for the uninsured population.Witnesses offered almost four times as many expressions of supportfor market rationalism than social insurance and three timesas many than for improving Medicare’s solvency/sustainability.The 2008 presidential candidates are split between support forsocial insurance and support for the private market. Medicare advocateswill need to devote extraordinary efforts to significantlycounterweigh the strength and influence of market rationalists.