Journal of Health Politics

In one way or another, the reform of American health insurance has been a leading political issue for much of this decade. Five years ago, the critical question was whether President Clinton's proposal for universal coverage through "managed competition" would be enacted (Hacker 1997). Today, the debate focuses on the quality of health insurance for those who have it. The rhetorical centerpiece is no longer "managed competition." It is "managed care"-a blanket expression denoting a mix of changes in private insurance that many Americans view with anxiety.

A striking feature of social policy in the United States is the heavy reliance of public agencies on private institutions. At the state and local level, social services are delivered through a welter of nonprofit organizations, community institutions, and profit-oriented providers.