Should a 97-year-old man undergo an expensive, dangerous open-heart operation to repair a lethal tear in a main artery of his heart? No, concluded the patient, Michael DeBakey, the world-famous cardiovascular surgeon who pioneered the operation. DeBakey's dilemma has become increasingly ordinary. Age is no longer the deciding factor, even for invasive treatment such as open-heart surgery. A more basic question is whether this never-too-old approach is an example of U.S. medical progress, or an example of why Medicare is headed for insolvency.