Steps toward universal coverage.

The health care reform debate of 1993-1994 revealed widespread recog nition that our nation’s health care system has significant problems. These problems did not end with the debate’s end in the 103d Congress. We therefore have no choice but to try again. Our new effort will reflect not only values and policy judgments but also political lessons from our recent experience. In this paper we argue that the fundamental goal of universal coverage can be pursued in steps. But these steps must be chosen with a clear eye toward building public support for and confidence in policy initiatives. Further, as we move, we must be sensitive to the risks of unintended consequences and invest in public education about costs and benefits. In legislation as well as in implementation, we must be sure that we are indeed moving forward, not backward.