The failure of comprehensive health-care reform during the Clinton administration (1993–4), has been attributed to many causes: structural features of the American political system, congressional gridlock, interest group opposition, President Clinton and his administration, even the ‘system’ itself. This article proposes an additional perspective: the views of the health policy community. Based on the work of Kingdon, Heclo and Walker, we suggest that fragmentation within the health policy community, particularly over policy solutions, was a contributing factor in the failure of healthcare reform. Our survey of health policy elites found that there was substantial agreement on problems of the health-care system coupled with substantial disagreement, based largely on ideology, about what to do about those problems. We also compared health policy elite views with those of the public. We found that, for the most part, the public and the elites disagreed on problems; however, they agreed on incremental changes, some of which were later enacted into law.
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