This paper considers the problems currently facing the Medical Assistance (Medicaid) program in light of the major problems confronting the American health care system. Actual and proposed Medicaid reforms are reviewed, their merits noted and their shortcomings detailed. It is argued that substantial Medicaid reform can take place only in the context of radical reform of the entire U.S. health care system. Similarly, Medicaid should be incorporated into any plan aimed at providing universal health care coverage.