ABSTRACT
The Great Depression seemed like a perfect opportunity for President Franklin Roosevelt to push through universal government health coverage. National health care reform bills were routinely introduced into Congress during the remainder of Roosevelt’s terms. The proliferation of managed care can be explained by the growing acceptance of market solutions for public problems. Health care reform seems to be saddled with an endless number of confusing expectations and goals. Proposed cuts in Medicaid at the federal level could force states to drop even more participants. Also likely to affect the availability of coverage is the power of managed care to hold down prices over the long run. Managed care has become so dominant that the entire health policy diffusion process seems to have slowed. Expansion of managed care to larger levels will eventually require wholesale revisions of Employee Retirement Income Security Act by Congress, which so far even Republican leaders have been hesitant to attempt.
