Abstract

comments and to the National Institutes on Aging for research support. At the dawn of the Clinton era, health care was poised to be one of the major issues of the coming decades. Health care costs were rising at a rapid rate and had been doing so for well over a decade. The number of uninsured was steadily rising, and the recession of 1990-91 had brought fears of uninsurance to the ranks of the middle class. Employers were increasingly shifting the costs of insurance to their employees, and employees were afraid to switch jobs for fear of losing their health insurance. Despite leading the world by a large margin in health care spending, health outcomes in the U.S. were no better than other developed countries in dimensions such as life expectancy and infant outcomes. This combination of rising costs, high uninsurance, and poor outcomes led to a crisis mentality in the U.S. health care system Moreover, a defining political event of the early 1990s brought health care to the national stage. The election of Senator Harris Wofford of Pennsylvania on a platform of major health care reform showed that this was an issue the public cared about. Candidate Bill Clinton embraced health care reform. The public responded favorably. Public opinion polls showed that health care ranked third on the list of voter concerns in the 1992 election, behind the economy and the federal budget deficit. With Clinton s ascension to the White House, there was every

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