Learning from the Health Care Systems of Other Countries

At the beginning of an election year in the United States, many are hoping that the election returns will be a clear mandate for health care reform. Not since 1992 has this prospect seemed so within reach. Then, many stars seemed to be aligned: The United States had been dealing with 14% annual increases in health spending and drug spending—and even greater increases in Medicaid spending. According to the polls, half of the country wanted health reform and felt it should be 1 of the 2 top priorities of the country. The incoming president had made health care reform his top priority, and his party controlled Congress. Indeed, the president followed through, and health care reform seemed inevitable. In the summer of 1993, a legislative aide to a prominent Republican congressman told me that his party felt as if it was in the path of a legislative avalanche. At best, it hoped to be at the bargaining table, to have a voice on issues that were important to their constituencies. The administration developed a complex plan. Many features of the plan seemed to reflect a …