Learning from the Health Care Systems of Other Countries At

the beginning of an election year in the UnitedStates, many are hoping that the election returns will be a clear mandate for health care reform. Not since 1992 has this prospect seemed so within reach. Then, many stars seemed to be aligned: The United States had been dealing with 14 % annual increases in health spending and drug spending—and even greater increases in Medicaid spend-ing. According to the polls, half of the country wanted health reform and felt it should be 1 of the 2 top priorities of the country. The incoming president had made health care reform his top priority, and his party controlled Con-gress. Indeed, the president followed through, and health care reform seemed inevitable. In the summer of 1993, a legislative aide to a prominent Republican congressman told me that his party felt as if it was in the path of a legislative avalanche. At best, it hoped to be at the bargain