The Illogic of Health Care Reform: Policy Dilemmas for the 1990s

After more than a half century, supporters of health care reform now argue that the passage of national health insurance is inevitable, for all of the major players in the health care policy arena-physicians, insurers, hospitals, and the mass public-are now favorably disposed toward reform. Periods of optimism are not new in health care debates in the U.S., but in each such era (in the 1930s, 1940s, and 1970s), reform efforts fell victim to ideological fissures in Congress, an overabundance of reform proposals, intense conflicts over what a new health care system should look like, and wavering support from the mass public. This article shows that all of these forces are again at work in the 1990s and may stymie national health care once again