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Frontmatter -- Contents -- Preface -- Introduction: The Puzzle -- Chapter 1. The Rise of Reform -- Chapter 2. A Prescription for Reform -- Chapter 3. The Liberal Synthesis -- Chapter 4. The Campaign -- Chapter 5. The Plan -- Conclusion -- Appendix A. Methodology -- Appendix B. Jackson Hole Participants, 1990-1992 -- Appendix C. California Insurance Commissioner's Health Care Advisory Committee -- Notes -- Index

In this volume, the nation's leading advisors on health policy and financing appraise America's ailing healthcare system and suggest reasonable approaches to its rehabilitation. Each chapter confronts a major challenge to the country's health security, from runaway costs and uneven quality of care to declining levels of insurance coverage, medical bankruptcy, and the growing enthusiasm for health plans that put patients in charge of risk and cost. Bringing the latest research to bear on these issues, contributors diagnose the problems of our present system and offer treatments grounded in

America's leaders say the economy is strong and getting stronger. But ordinary Americans aren't buying it. They see what the rosy statistics hide: We are all struggling under the weight of terrifying economic instability. No matter how well educated and hard working we are, we know that the bottom can fall out at any moment. Meanwhile, the safety net that once protected us is fast unraveling. With retirement plans in growing jeopardy while health coverage erodes, more and more economic risk is shifting from government and business onto the fragile shoulders of the American family. In The Grea

Growing interest in "Medicare for All" has revived hopes for universal health insurance. Yet serious disagreements remain over how to expand Medicare and how far to move toward a universal Medicare system. In this article, I consider these disagreements in light of what we know about "policy feedback"—the ways in which policies, once enacted, reshape public opinion, governing institutions, and political organizations. Rather than focusing on the "political feasibility" of proposals for Medicare expansion, I focus on their "policy sustainability": whether proposals, once enacted, can be established in place, entrenched over time, and expanded and improved as circumstances change. Achieving these "three E's," I argue, requires a flexible approach that builds on the current system (and hence falls short of Medicare for All) but also contains a universal coverage guarantee and other provisions designed to create strong feedback effects conducive to the expansion of Medicare over time.