It's a girl! My doctor's long-awaited pronouncement heralded one of the most joyous moments of my life. More surprising for this first-time mother was the extent to which so many people shared in our enthusiasm. Not just family and friends but my employer, banker, the owner of the local Chinese restaurant, even the farmers at the local farmer's market. They sent gifts, cards, and messages to demonstrate their affection for the precious addition to our family. The notable exception in this celebration was my health maintenance organization (HMO). When an HMO representative called, it was to deny financial responsibility for my daughter's care.

I have devoted the past ten years of my career to working on ways to make a private, employer-based health care system work more effectively. I believe that HMOs can be part of the solution. From 1997 to 1998 I directed the staff work for the chair of the California Managed Health Care Improvement Task Force. The following year I led a study aimed at improving health coverage decision making in California. To learn that I had been denied health care services was personally disappointing and, considering my professional expertise, ironic. We all hear stories of coverage and claims denials, but when it happened to me, I understood the intense anger people feel about these episodes. My experience resulted in a clearer understanding of why HMOs are so widely disliked.

First published in Pharmacoeconomics, Volume 14, pages 27-48, 1998.

Studies in the Economics of Aging is the fourth book in a series from the National Bureau of Economic Research that addresses economic issues in aging and retirement. Building on the research in The Economics of Aging (1989) , Issues in the Economics of Aging (1990), and Topics in the Economics of Aging (1992), this volume examines elderly population growth and government spending, life expectancy and health, saving for retirement and housing values, aging in Germany and Taiwan, and the utilization of nursing home and other long-term care.

Japanese and American economists assess the present economic status of the elderly in the United States and Japan, and consider the impact of an aging population on the economies of the two countries.

With essays on labor force participation and retirement, housing equity and the economic status of the elderly, budget implications of an aging population, and financing social security and health care in the 1990s, this volume covers a broad spectrum of issues related to the economics of aging. Among the book's findings are that workers are retiring at an increasingly earlier age in both countries and that, as the populations age, baby boomers in the United States will face diminishing financial resources as the ratio of retirees to workers sharply increases.