3 Stan. L. & Pol'y Rev. 146 (1991)
Public Opinion and Efforts to Reform the U.S. Health Care System: Confronting Issues of Cost-Containment and Access to Care

handle is hein.journals/stanlp3 and id is 148 raw text is: Public Opinion and Efforts
to Reform the U.S. Health Care
System: Confronting Issues
of Cost-Containment and
Access to Care
by
Robert J. Blendon
Karen Donelan

For the third time in the post-
World War II period (earlier de-
bates occurred in the Truman and
Nixon presidential terms), national
attention is focused on whether
the United States should reform
its current health care system and
enact a universal health insurance
program. Opinion polls indicate
that support for a national health
plan is at a 40-year high'. Since

The American
public is deeply
anxious about
its ability to cope
with rising
medical costs in
the future.

1989, nine national and statewide surveys indicate that
between 60 and 72% of Americans favor such a plan.
Some of these figures indicate that current public
enthusiasm for a comprehensive national health insur-
ance program exceeds the level of popular support for
Medicare in the year prior to its enactment. In fact, a
recent Roper Organization (a national polling organiza-
Robert J. Blendon, Sc.D., is a Professor and Chairman of the Depart-
ment of Health Policy and Management at the Harvard University
School of Public Health. Karen Donelan, Ed.M., is a Research
Specialist and Doctoral Candidate in the Department of Health Policy
and Management at the Harvard University School of Public Health.

tion) survey indicates that 69% of
Americans surveyed approve ex-
tending Medicare coverage to all
citizens.2
Before discussing the issues
that underlie this new wave of
interest in a national health plan,
it seems worthwhile to explore why
the more than 50 national health
insurance initiatives that have
been introduced in the U.S. since

World War II have all failed. Many of these efforts were
comprehensive in scope, included well developed cost-
containment programs, and were sponsored by prominent
leaders from the public and private sectors and by health
organizations.' The dynamics behind the rejection of
these previous proposals clearly have implications for any
future debate about this issue.
For many years, historians and policy analysts have
suggested that the failure of earlier national health
proposals resulted primarily from the continued and
strident opposition of the medical profession to the imple-
mentation of such a plan. While acknowledging the
crucial role organized medicine has played in the failure of

STANFORD LAW & POLICY REVIEW

146

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