In our pluralistic society, the trends in social policy often swing like a pendulum. They overcome inertia and gain momentum in one direction only to swing back the other way, ultimately settling somewhere near the gravitational center. In issues such as personal health, which touches the lives of all of us, interest in that center is likely to be strong. In 1994, the country rejected a large government role in health care and began to pursue a market-based system. But five years later, after sampling the benefits and detriments of market-based medicine, the pendulum has begun to swing the other way. Legislation to regulate managed care has proliferated at both the state and federal levels of government and is at the top of the congressional agenda as we advance through the last year of the millennium. Policymakers, clinicians, and consumers are struggling to find the right balance between competition and regulation that will result in a high-quality and compassionate health care system, accessible and affordable to all Americans. This volume, with contributions by many of the nation's leading experts in health care policy, provides a comprehensive examination of the issues from a broad range of political perspectives.
In the late 1980s and early 1990s, annual increases in health care inflation were in the double digits, and employers and consumers found health insurance increasingly unaffordable. In response, the Clinton administration attempted to legislate comprehensive health care reform. But the country rejected the government's large role in that plan, and instead pursued marketoriented reforms based on a system of competitive managed care.
Enrollment in managed care organizations grew rapidly during the 1980s, and many analysts have expounded on the potential virtues of managed care: to make the delivery of health care