Medicare is becoming an anachronism. The demographic and medical realities of the twenty-first century mean that Medicare can no longer provide every citizen with 'free' access to all the new medicine. Without reform, healthcare in the 2040s is likely to be increasingly about rationing. Jeremy Sammut outlines the combined impact of demographic trends toward ageing and the increasing costs of new high-tech medical technology on healthcare supply and demand in the future. As well as the implications for intergenerational conflict as the baby boomers begin to expect Generations X and Y to bare the tax burden for their care.