Every year, the trustees of the Medicare program release actuarial data and projections about the short- and long-run financing and operations of this critical program. (The trustees of the Social Security program simultaneously release actuarial data and projections.) The lengthy Medicare report is always news-worthy. After major Medicare legislation it becomes even more important, for it gives some basis to understanding the long-term effects of the new law, while also providing substance to lawmakers who may be working on legislative modification. In an election year, however, its impact is even greater. This report provides an outline to many issues that will play out in the campaign for both candidates, and facts, figures and inferences will be used to partisan effect In an effort to give the reader a scorecard for understanding future discussions, I present some facts, the spin and some prognostications about the future of this important program. Finally, I will suggest how we, as radiologists, should use this information to guide future decision making.