The long-anticipated surge of retiring baby boomers is upon us. The Medicare trustees recently estimated that Medicare Part A (the hospital insurance trust fund) will go bankrupt in 2026, only eight years from now—and three years sooner than they predicted in last year’s report. Consumer decisions and behavior provide important clues about where policymakers can go from here. For decades the debate in Washington has centered on benefit expansion, benefit reduction, or tax increases. In the real world, consumers are offering a fourth way to preserve Medicare: choice and competition.