Commissions, clubs, and consensus: Florida reorganizes for health reform

This paper explores the political dynamics by which a health reform leader state--Florida--engineered an ambitious reorganization of state health agencies as an expected prelude to bolder policy measures before the end of 1994. Demographic and fiscal pressures spurred the state to action, but its success at innovation demands a political explanation. This narrative highlights Florida's patient quest, by means of commissions and task forces, for common ground among parties of diverse dispositions; the sagacity of would-be innovators in wielding a potent policy "club"--the prospect of a single-payer system--to encourage a search for common centrist ground; and the consensus- and coalition-building skills of the state's leading executive and legislative figures. Florida's political skill has sustained impressive departures, but the hardest questions--how to finance universal coverage, how to secure universal access, and how to keep it all affordable--remain to be answered.