Commentary The Politics of Reform

The articles on individual health insurance market reform in this issue raise fundamental questions ahout the role of competitive markets in pro-moting access to health care. The decision to impose new restrictions on insurers, or conversely, not to regulate insurers ' rating and enrollment practices, rests on certain core assumptions about how the world works (Thompson 1981). ln New Jersey, for example, policy makers viewed rat-ing and enrollment reforms in the individual health insurance market as a means to reduce the number of uninsured persons (Garnick, Swartz. and Skwara 1998). This basic policy hypothesis unciergirds Individual insurance market reforms such as the removal of preexisting-condition clauses, limitations on underwriting practices, and the introduction of community rating. If this assumption is tlawed, however, incremental reforms will be ill-equipped to address many of the most significant shortcomings ofthe marketplace. The articles in this issue return to the familiar "competition versu