The joining of the problem, policy, and political streams again forced open a small window of opportunity for modest, incremental reform during 1995-96. There was a recognition on the part of the policy makers that specific problems of the uninsured and the Medicare and Medicaid programs needed to be addressed without trying to overhaul the whole system. A number of piecemeal reform proposals were introduced in Congress. Some of the major reform proposals were the Kassebaum-Kennedy health insurance legislation designed to address the problems of the uninsured, legislation to create medical savings accounts, product liability reforms, and proposals to cut Medicare and Medicaid programs. Chapter 4 provides a detailed analysis of the outcome of these proposals.
This chapter has examined the process of policy agenda setting. We looked at why the issue of health care reform returned to the national policy agenda during the early and mid-1990s. During this time frame, the issue of health care reform moved from a systemic agenda to an institutional agenda. One might say that before the 1993-94 reform period, if polls are any indication, the American public was not merely supporting a major overhaul of the health care system but demanding it. By 1995-96, though the support for a comprehensive reform had declined, support from the general public for an incremental approach to reform remained strong. During both reform periods, a number of internal and external triggering devices helped the issue of health care reform reach policy agenda status.
One of the reasons all previous efforts at comprehensive health care reforms, especially for the establishment of a national health insurance system, had failed in the twentieth century (discussed in chapter 1) was the fact that powerful organized interests with access to institutional gatekeepers prevented this issue from achieving a policy agenda status or exercised their "veto power" once the issue had reached the policy agenda. The result often was a "nondecision" on the part of policy makers. At least in the beginning of the 1993-94 reform period, however, this situation changed. Most organized interest groups came to recognize the need for reform, even though they ultimately could not agree on the precise nature of the reforms. Even during 1995-96, most organized interests came to recognize that something needed to be done about the problems of the uninsured, Medicare, and Medicaid.
During both reform periods, many indicators pointed to a significant number of problems in the U.S. health care system, and policy makers came