On two mornings every month between September and January, a long line of people waits to enter a wood-paneled meeting room in the Ronald Reagan Building in downtown Washington, DC. Whether they are lobbyists, regulatory consultants or patient advocates, the people in line all have a special interest in health policy. They come to pack into tightly squeezed chairs that fill one half of the meeting room and listen intently, while on the other side of the room, 17 appointees gather around a large, U-shaped table and discuss issues related to the Medicare program. These 17 appointees, and the staff that support them, make up the Medicare Payment Advisory Commission (MedPAC), and the discussions they have between September and January each year inform the contents of a 500+ page report delivered to Congress every March. The report exhaustively examines all parts of the Medicare system and makes specific recommendations to Congress on ways to constrain Medicare program spending while ensuring beneficiary access to high-quality care.