FOUR YEARS AGO, in the presidential campaign, in major medical journals and medical associations, in the media, and in civic groups, our nation was engaged in a great debate about the best way to provide health insurance coverage to all Americans. By contrast, these debates have been conspicuous by their absence in this election year. The health system reform debate was marked by some controversy about whether there was a health insurance crisis at all.1On one side were those who said that most of the uninsured could get care when they needed it, a view that was expressed in a commentary in theWall Street Journalin 1994 that noted that "these [uninsured] citizens are not denied health care" and only 1 in 5 uninsured (about 3% of the population) cannot obtain affordable insurance.2On the other side were those who claimed that many of the uninsured