Introduction

Following the collapse of President Bill Clinton's health reform proposal in 1994, most elected officials became unwilling to talk about major government action to change private health insurance arrangements. Democrats were shell-shocked by the political fallout from the Clinton debacle, to which some attributed the loss of control of both houses of Congress in 1994. Most Republicans were ideologically unsympathetic to federal tinkering with private health insurance decisions. And so for years both parties shunned the issue. No longer. Health system reform has once again become politically salient, consistently ranking among the top three issues in public opinion polls, along with the Iraq War and the economy.¹ Presidential candidates in both parties have put forward alternative visions of how to reform the delivery of and payment for health care services.