Why Is It So Hard to Reform Healthcare?

Healthcare reform is unique as a policy issue in that the process itself commands almost as much attention as the content of the legislation. It’s probably an unhealthy obsession, but it’s one that has developed over half a century of failures. Passing legislation is never simple, but what in particular about our healthcare system makes it so difficult to change?

Conservatives like to argue the reason we have our current healthcare system is that we are a fundamentally conservative country that does not like excessive government intervention in markets (even though the current proposals would do much more to open up the health insurance market). This is similar to the refrain commentators made after the election that this country is fundamentally “center-right” and that Obama’s election was only a temporary blip.

The evidence seems to suggest that it has a lot more to do with the structure of our institutions than with American ideology. Many Western European governments have a Cabinet that also sits in the legislative branch in government. If Gordon Brown decides to push a domestic policy issue through Westminster, he can expect to receive near-unanimous support from his party and a loud, but usually futile, opposition. Unlike the U.S. Congress, the outcome is rarely in doubt in London and modifications are substantially fewer. What the British Parliament lacks in deliberativeness, it gains in responsiveness.

Conversely, in foreign policy, the U.S. presidential system is a lot more decisive than parliamentary systems. If a foreign policy crisis arises, the president can expect to have wide latitude and support. Stephen Maloney, a political theorist, makes the point that tactics such as the “oversell” (hyping a threat to stifle dissent) that normally work in foreign policy are ineffective in domestic policy when the executive branch is subservient to Congress. The Obama administration is wholly cognizant of this limitation and has tried its best to withdraw from the detailed writing of the legislation lest they be unfairly blamed for its failure.

All forms of government have different capabilities and strengths; planning comprehensive healthcare reform is clearly not a strength of our constitutional system.

The views expressed in this blog do not represent the views or opinions of Generations United.