The Mirage of Reform

This chapter is eerily similar to the headlines in the paper this week. As McCain and Obama make their final pushes for the White House, we have heard socialism thrown around as an insult. We have heard about privatizing health care, about establishing national health insurance. It leaves one to wonder whether the efforts of either President-elect will come to fruition, or flounder like the efforts before them.

It seems that the greatest barriers to success are interest group politics and division of efforts. It is interesting to note that incrementalism, in this view, served to stratify and distract from a larger effort. As specialty hospitals weighed their options, they chose to go off individually and focus on their own agenda, rather than a group agenda. This is an oft-observed phenomenon. Tiny factional groups will work on their own piece of an issue, not because they are unable to see the larger picture, but because the resources required for collaboration, the high likelihood of failure and the sheer challenge of coordinating a large agenda overwhelm collective efforts. In local government, we are starting to use the term "collaborative governance." This replaces thirty vogue terms before it, but captures the challenge of change in an environment of significantly limited resources. We all have goals, individually and collectively and many of these goals actually have a high level of overlap. Collaborating in way that facilitates the achievement of these goals for more than the individual, however, requires sacrifices from all participants. In a group setting, sacrifice is political. Those who feel compelled to sacrifice sense a loss of power.

As we move towards election day and more importantly, into a new presidency, it will be interesting to observe the efforts towards health care and track them against this chapter and indeed this book. To watch? Interest groups, political compromise and scaling back of goals from the lofty to the achievable.