3
The reforms that were enacted during this period in the 1980s and beginning of the 1990s
exemplified this negotiated health care regime. Leaders “were more concerned with piecing
together a set of tangible and politically viable reforms than with engineering an intellectually
coherent product.”
8
Indeed, these reforms were far from perfect solutions, often taking a
“patched on” quality. The percentage of those without health insurance actually rose slightly
during the economic boom in the mid and late-1990s, from 13.4 percent in 1990 to 14.3 percent
in 1999. This was almost entirely due to the drop in employer-provided health insurance; while
the percentage of people insured by public programs remained steady, the percentage of people
getting insurance from their employer dropped during that time period from 73.2 percent to 71
percent.
9
Any efforts to understand the prospects for systemic and effective health care reform
must take into account the significant changes to parties and labor in the last twenty years. Both
have changed due to the same larger contextual changes in American political and economic
development: the rise of candidate-centered campaigns, the nationalization of politics, the
formation and power of advocacy and public interest groups, and rise of the service economy.
At the state level these changes have contributed to increased political competition between the
parties, larger influence of the national parties on state parties, and the decline of bipartisanship
at the state level. Too, we have seen the decline of traditional manufacturing and trade unions
and the rise of service and government employees unions, and a gradual erosion of the
relationship between business and labor that was the impetus for many private sector reforms as
8
Thomas R. Oliver and Pamela Paul-Shaheen, “Translating Ideas Into Actions: Entrepreneurial Leadership in State
Health Care Reforms,” Journal of Health Politics, Policy and Law 22 (1997): 721-788 , 746.
9
U.S. Census Bureau, “Historical Health Insurance Tables,” at
http://www.census.gov/hhes/hlthins/historic/hihistt1.html
. Accessed April 15, 2004.
Convention