Some antecedents to healthcare reform: Israel and the United States

This article addresses the question of what enabled the passage of Israel's National Health Insurance Law in 1995, after decades of failed attempts, and tries to learn from this some of the reasons why United States President Clinton's health reform efforts foundered. It argues that in Israel reform was preceded by major changes in the society as a whole - in its values, in the power of the organised para-political opposition, and in the political configuration in which that opposition functioned - and suggests that the absence of such changes contributed to the failure to enact healthcare reform in the US. It also points out that, unlike Clinton's comprehensive health plan, the 'reform' in Israel was in fact a narrow political reform which gave the government more control over health policy but had little impact on how Israelis pay for or receive their healthcare, and did nothing to contain costs.