Here We Go Again Lessons on Health Reform

For this month's edition of Health Affairs, the preeminent health policy journal, I was asked to contribute my thoughts on the health care reform debate engendered by the presidential election season. I addressed the same topic in this journal in 1989 while on the White House staff. As I reflect on my views some 18 years ago, I am struck by how little has changed in the health reform debate.

Presidential elections place important issues front and center for the American people. Over the next 12 months, we will hear varying plans to make fundamental reforms to our health care system. The discussions on the campaign trail and at family kitchen tables will be helpful in defining hypothetical changes to a system that is in need of major reforms. However, when the dust settles, will we experience fundamental reform? I think not.

More of the same is the theme of the article. But I don't mean that cynically. While politics plays an important role, I firmly believe that advances in medicine, science and technology will do more to reform our health care system than anything that may happen in Washington.

As with any complex issue, there's always another view. I encourage you to share your thoughts on the subject.

To read the full article in PDF format, visit

To access the article I wrote in 1989, click here.

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