• Responsibility and the Structure of Government

    Continuing Catharsis Week, my colleague Steve Pizer and I wrote a Kaiser Health News opinion column that appears today. In it we note the rare demonstration of responsibility of congressional Democrats and the Administration that brought us so close to health reform. Then we explain the forces that contribute to the scarcity of responsible government and to the near collapse of the health reform effort. Just a taste:

    Our system of government is designed to produce an abundance of great speeches about sweeping reforms and a pittance of actual reform delivered. So, except for frustratingly brief moments, we really have no government, just a collection of perpetual campaigners, focused on the next election and accepting no responsibility for the country’s long-term problems. In 2009 it was comforting to believe that the leaders of the majority party would use their power to govern responsibly. They tried and failed. The campaigners have taken over, again.

    Please read the whole thing.

    Though I agree with what we wrote, I’m still disappointed in Democrats for not (yet?) finishing the job they started. The design of our government certainly makes it far harder for leaders to govern responsibly. I get that. But I’m not willing to give the Democrats (or Republicans) a free pass. Perhaps it is because some of them certainly appeared to want to do the right thing. That gave me hope. Then it was crushed, maybe to be revived once more (I still can’t tell).

    The last time I was so disappointed in a political party and a president was when George W. Bush took us to war in Iraq. Like the abandonment of compressive health reform, that too was an unnecessary and costly decision that resulted in loss of life. It is hard to forgive, and harder yet to forget, leaders who trade blood and treasure for political gain. I understand why they do it. I just don’t like that they do so. I never could. And that’s why I do what I do and not what they do.

    But few of us are 100% free of responsibility and power, small though it may be. Most of us can vote. We can also write or talk to our representatives and/or their staff members. We can demonstrate, volunteer, and contribute money. In small ways we can do something toward making our dysfunctional government and the actions of our leaders ever so slightly better.

    Last week I called my Democratic congressional representatives and urged them to continue to fight for health reform. (You can too. Here’s where to find contact info.) If I perceive for a moment that they are not seizing opportunities to make progress on coverage and costs they will lose my full support, and possibly all of it. The same goes for our president.

    I don’t expect to have my way on every issue. I understand political realities and the limitations of our government. But I do expect my representatives to do their job within the constraints of our system. When, despite the incentives for irresponsibility, there is a chance to do the right thing, to begin to address a pressing national problem, and when the (super) majority exists to carry it out, then it should be done. On health care it wasn’t, or hasn’t been yet. Democrats defeated themselves once last week. But it is within their power to change course. If they throw in the towel for good that will be a loss for which we will all pay.

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    • I wanted to thank you for the article I read in Kaiser. As a home health nurse of over 20 years, I have many concerns about what will happen to both patients and providers if health care reform is not accomplished in a way that addresses the needs of our communities, financial viability of health care organizations, and is sustainable without bankrupting my children and my future grandchildren. Your comments about the differences between our government and those of other countries really crystalizes the barriers we face in making any meaningful reforms. I am proud to be American, and truly believe we live in the best country in the world. It just makes me sad to think our politicians won’t make difficult decisions and thus the status quo goes on and on. Of course everyone pushes for what works best for them; that’s why we need people leading who decide what is best for us all. I plan to print the article for my teenagers, who have asked me several times why it has been so hard to get the reform through. You’ve hit it on the head. Thanks.

      • @Wendy – You get the nicest comment award! Thanks.

        I’m struck by the extent to which Americans blame politicians for government’s failures when a good portion of the blame rests with the structure and processes of government itself. It’s a pretty tall order to expect Americans to understand the limitations of government, but they are considerable. One only needs to look around the world to recognize it.