The 1990s may prove to be one of those rare decades in political astronomy in which the constellations of public and elite opinion will be in perfect alignment. According to an August 1991 Gallup Poll, 91 percent of the American people feel that the nation's health care system is in a state of crisis, an assessment, if the 1992 presidential campaign is any indication, uniformly shared by the nation's political leaders. 1 As Senator Paul Wellstone (DMN) put it, health care reform "has become the functional equivalent of kissing babies." 2
Reforming the nation's health care system has been catapulted to the top of state and national policy agendas by several factors. The first is the rapid increase in the number of Americans without health insurance: from 1989 to 1990 1.3 million people joined the ranks of the 35 to 38 million uninsured Americans. Significantly enough, three-quarters of the newly uninsured had annual family incomes of $25,000 or more. No longer is it simply the poor who must be concerned about access to health care. This factor alone changes the prospects and politics of health care reform.
Second, public opinion polls indicate that after years of being insulated from, and seemingly unconcerned about, rising health care costs because of third-party (e.g., private health insurance, Medicare, and Medicaid) reimbursement, even those with health care insurance now recognize the impact on their lives of skyrocketing costs. Gallup found that concern with the cost of health care and health insurance far out-