This essay focuses on the basic design of the Clinton administration’s health-care-reform policy. It examines how the president’s early decision in favor of employment-based private insurance rather than tax-based social insurance led to an unnecessarily complex program. While recognizing that the administration’s reforms would provide coverage to millions of Americans who now have no or inadequate insurance and would improve the way health care is financed in the United States, I argue that we would still fall short of the universal and progressive program our nation ought to have.
I will discuss three central questions: What should the goals of reform be? Are the Clinton administration proposals heading in the right direction? What sorts of ideas and political mobilization will it take to push reforms in the right direction? But I must begin with some more general remarks about why the administration developed its complex and complicated program. I will then turn to the consequences that follow from that fundamental choice....
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