The Prospective Payment System and the Medicare Fee Schedule, two of the most effectively sustained and successful efforts at policy innovation in history continue to shape decisions about Medicare and cost containment efforts. Smith shows how particular policy alternatives were developed; why chosen or rejected; and how provider interests and American political institutions have shaped their design and implementation. David G. Smith is professor of political science at Swarthmore College. He has been a board member on many health-related organiations. His main teaching areas include health policy, Constitutional law and jurisprudence, American government and politics, and political theory.