Twenty-five years ago it seemed that America was on the verge of universal health care coverage.1 A large and growing number of workers and their dependents had gained employer-based health insurance coverage.2 Medicaid and Medicare were enacted to serve the needs of those who did not work—notably the poor and the elderly. Direct service programs, such as community health centers, maternal and infant care projects, and children and youth projects, were also established in the mid-1960s to serve low-income families. At the time, it appeared that this pluralistic approach to financing health care was leading to universal access to health care.
- Received March 1, 1990.
- Accepted May 16, 1990.
- Copyright © 1990 by the American Academy of Pediatrics