Why U.S. Health Care Reform Is So Difficult

Abstract

Health care reform now heads U.S. domestic agenda, but this generation of policymakers may be less successful than its predecessors in effecting major changes. president wants universal coverage and a wider array of services. Key members of both parties, such as Senators Dole and Moynihan, resist anything grandiose. Yes, there are problems, declared Republican congressional leadership. there's not an emergency that requires a complete overhaul of medical system.[1] current debate pits visions of justice and fairness against fears that reforms may prove more costly and cumbersome than maintaining status quo. Promoting the general welfare is tough in a country where progress is measured incrementally. Advances occur in fits and turns, watersheds alternate with retrenchments. The two parties which divide state, party of Conservatism and that of are very old.... Reform is affirmative, conservatism negative, Ralph Waldo Emerson observed in 1841. The Conservative assumes sickness as a necessity, and his social frame is a hospital.... Reform converses with possibilities, perchance with impossibilities. In this dialectic, Innovation is salient energy; conservatism pause on last movement.[2] Reformism's ebb and flow was not a uniquely American characteristic; liberals fought conservatives everywhere. But Emerson claimed that U.S. politics had generational underpinnings. Fresh ideas came from new blood, from reformers surmounting old ways and vested interests--rest, conservatism, appropriation, inertia; not newness, not way onward.[3] Partisan battles here were ideological, waged by forward-looking members of a rising generation against elderly guardians of established order. Sometimes, of course, members of same cohort represented interests of innovation and conservatism. Debating among themselves a generation earlier, for instance, Founding Fathers wrestled with how to balance creative policy recommendations advanced by leaders coming into their own and prudent voices of those who valued steady hand of tradition. From late 1780s until his death, Thomas Jefferson stressed that each generation had the right to direct what is concern of themselves alone, and to declare law of that direction ... to make Constitution what they think will be best for themselves. Jefferson wrote in a letter in 1816 that Constitution should make provisions for its own revision every nineteen or twenty years, so that it may be handed on, with periodical repairs, from generation to generation, to end of time.[4] James Madison, in contrast, stressed importance of continuity in transferring rights and responsibilities from generation to generation. There seems then to be a foundation in nature of things, in relation which one generation bears to for descent of obligation from one to another, Madison wrote to his neighbor at Monticello in 1790. Equity requires it ... [and] good is promoted by it.[5] Given humans' innate capacity for selfishness and opportunism, Madison relied on traditional conventions--instilling a sense of duty in citizenry, honoring contracts that were legitimately made by representative governments--to dilute naivete of political neophytes and to mitigate establishment's abuse of power. At still other critical moments in our history, U.S. politicians have muted inter- and intragenerational disagreements over policy differences. Lawmakers in depths of Great Depression emphasized that relief, reform, and actually offered best way to preserve core of American experiment. Thus, in bringing together experts to draft social security legislation, Franklin Delano Roosevelt declared: Our task of reconstruction does not require creation of new and strange values. …