Why Health Care Reform Failed

Sometime in late 1992, there was a rally in Little Rock, Arkansas, where President-elect Bill Clinton was busily sorting through résumés and position papers. Although the rally drew about a thousand people, it was little noted in the major media; I learned of it in Nation’s Health, a weekly newspaper devoted to health care issues. The rally was held to promote a single-payer health care plan, the system by which the federal government would direct health care—would become, in the argot, the “single payer” of reimbursements to health care providers.

Under single-payer, health care would no longer be tied to employment and would thus be universal; the payment of insurance premiums, which finance health care now for all Americans except those on Medicare and Medicaid, would end, to be replaced by taxes. There being no insurance pools or health maintenance organizations under single-payer, people would be free to choose whatever primary care doctors they lik...