Through the lens of political and moral economy, I examined the dominant values and actors in the legislative process of the Medicare Modernization Act of 2003. In my content analysis of federal hearings, I found that witnesses from government agencies, Congress and think tanks had almost equal presence at the hearings. Witnesses who were invited by Congress to testify at the hearings expressed twice as much support for private interests than for the general Medicare population or low-income beneficiaries. Few expressed concern for the uninsured population. Witnesses offered almost four times as many expressions of support for market rationalism than social insurance and three times as many than for improving Medicare's solvency/sustainability. The 2008 presidential candidates are split between support for social insurance and support for the private market. Medicare advocates will need to devote extraordinary efforts to significantly counterweigh the strength and influence of market rationalists.