Abstract
The conventional wisdom among health policy makers now holds (as it did 20 years ago) that major federal reform in our health system is just a matter of time. This view originates in the extraordinary economic, social, and ethical tensions created by a system that consumes 12 percent of our gross national product while failing to provide any insurance coverage to 31 million citizens.1 Business, it is argued, will soon rebel against the cost of health care. The public at large, scandalized by the plight of the uninsured and insecure about eroding private health care coverage, will support a guaranteed . . .

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