ABSTRACT
Hawaii and Oregon were two of the first states to enact universal access laws. The two plans are very different and indicative of the variety of external factors which often drive such reforms. This chapter examines these two systems through the use of case studies in an attempt to identify political, cultural and financial forces which led to passage of large scale reforms. Even in the earliest days of the kingdom of Hawaii, the central government supplied at least rudimentary health care to all members of society. In 1947, the Hawaiian legislature had considered bills requiring employers to provide health insurance for workers. In 1968, the body funded a study on prepaid health insurance. The Oregon Health Services Commission reviewed health systems in Canada, Great Britain, Japan, Sweden and Germany. Oregon is a state of paradoxes. Settled mainly by pioneers of European descent, early in the twentieth century the state became famous for passage of a number of progressive reforms.
