Health Care Reform in the 1990s
Over forty years ago, Democratic presidential candidate Adlai Stevenson suggested that sickness and health should be treated in the same way that a war is, because they are both matters of life and death. Sickness and health have not always been treated like a war, but the question of health care reform in the early 1990s did have many similarities to martial scenarios. Battle plans were drawn up on each side. Offensive and defensive strategies were developed. Considerable resources were marshaled in order to wage vigorous campaigns. And, ultimately, there were winners and losers.
As previously indicated, the issue of developing some type of comprehensive reform of the health care financing and delivery systems in the United States was not a new one. Major reform proposals had worked their way onto center stage on several different occasions over the last eighty years or so. That issue emerged in full force once again in the early 1990s. Although some scholars like Luann Aday ( 1993) felt that the central features of any debate or discussion regarding health care and reform should focus on improvements in preventive care and public health services, most would agree that the real focus of attention in the early 1990s revolved around issues of cost and access. Indeed, reform advocates painted a dismal picture of both rising costs and reductions in access to delivery of health care in the United States. Opponents of comprehensive reform efforts often focused on the risk of expanding the role and scope of the federal government to implement and carry out reforms. One can shed much light on the situation in the early 1990s by examining both the case for and the case against comprehensive reform of the health care system in the United States.
Advocates of comprehensive reform of the health care system in the United States have long charged that the status quo is simply inadequate. Millions of individuals and families lack basic health care coverage, and the costs associated with financing the present system exclude millions of others. Hanson ( 1993) summarized the overall position of advocates for comprehensive reform: