HEALTH CARE REFORM RETURNS TO THE NATIONAL AGENDA: THE WINDS OF CHANGE
Health care reform returned to the national policy agenda in the early 1990s, opening a window of opportunity for a major overhaul of the U.S. health care system. No other issue dominated the national domestic policy scene and captured the public's attention and focus as much as this one. Public debate over the problems of the U.S. health care system and the kinds of reforms needed to address these problems took the front stage in both the public and the private sectors. The debate over health care reform gained prominence in the print (editorials, guest columns, letters to the editor, etc.) and electronic (national and local news, talk shows, special reports, etc.) media.
Before the 1990s, several major attempts to reform the U.S. health care system resulted in failure, as mentioned in chapter 1 ( Marmor 1994b; Rothman 1993). What forces caused the issue of health care reform to reemerge on the national policy agenda in the United States in the early 1990s? The answer to this question requires some understanding of the policy cycle and its processes.
A policy cycle consists of a series of steps or stages. The first step in the policy cycle is an agenda-setting process. This includes the emergence and recognition of a public problem or issue and the placement of this problem/issue on the policy agenda of the government. The second step involves policy formulation and adoption. This step includes specification and consideration of available alternatives to address the problem(s) and the decision about whether to adopt a new policy or change existing policy. Successful policy adoption leads to the third step, policy implementation. This involves administration of a program or enforcement of a policy. The next step is policy evaluation, which provides feedback about the success or failure of the policy in addressing the