Health Care: An American Report
It is most important for the analysis and understanding of recent events in regard to health reform in the United States to recognize that we have a rich, eight-decade-long history of failed attempts at comprehensive reform. Last year's ( 1994) health insurance bill was not our first attempt (nor, as it turned out, will it be our last) to erect a system of universal coverage. Importantly, however, it was our first attempt to weave a universal financing proposal into a fabric that also stressed expenditure containment via major delivery-system reform. It would have been far simpler for us, in terms of the cost and complexity of health care, had we moved to universal insurance early in this century, as suggested by Presidents Franklin D. Roosevelt in the 1930s, Harry Truman in the late 1940s, or even later by Richard Nixon in the early 1970s.
I stress the importance of the historical perspective because I believe that it is a mistake simply to focus on what happened last year and thereby assume that the full explanation for failure lies in events, personalities, and processes unique to that particular effort. That kind of "instant analysis" encourages a shallow voyeurism and silly gossip. Even worse, it trivializes the problem.
Of course, events, personalities, and processes made a difference, but in my judgment, more basic factors were at work. Put simply, I do not believe that, within the constraints of our political system as they were perceived by most politicians and political pundits, different tactics would have