The result of these errors and omissions was that thirty-five percent of the population was without any health insurance coverage, and sixty to seventy million people nationwide were without adequate access to high-quality medical care.

Reform of the medical care system was an important issue in the 1992 election campaign. Numerous plans were supported by the candidates and discussed in congressional committees. The American College of Physicians, the largest medical organization in the United States after the AMA, supported the concept that adequate medical care is a right, not a privilege, and that universal access can be achieved only through system-wide reform. It suggested four principles: (1) assuring access to care; (2) assuring high-quality, comprehensive coverage; (3) promoting innovation and excellence; and (4) controlling costs by a combination of employee-sponsored and publicly sponsored insurance covering the entire population. To bring these changes about, private insurance companies would need to provide benefits identical to those in publicly sponsored plans. All patients would be eligible regardless of prior existing conditions; coverage could not be canceled and could be transferred to other employment.

It was considered imperative by policy makers and practitioners that national health care spending be capped at the 1992 level of $800 billion. The savings gained by eliminating inflated administrative costs, needless duplication of facilities, overpriced care, and unnecessary malpractice suits would provide for complete coverage of the entire population.