Klein: How Special Interests Could Block Health Reform

As long ago as 1982, the economist Mancur Olson made the argument, in The Rise and Decline of Nations, that as a democracy matures, special interests grow more entrenched. Their intense dedication to their own specific needs, Olson wrote, often trumps the broader, but less focused, interests of society. And that was before the rise of cable news and talk radio. It was before the utterly corrupting effect of televised advertising on politicians really kicked in — the need to raise money (from interest groups, mostly) and to exercise extreme caution lest one of your votes be used to decapitate you in a 20-second ad. It was before the Democrats and Republicans transformed themselves into more strictly ideological parties. Put all these factors in the cauldron and you create a poisonous atmosphere that makes legislative action on big issues almost impossible. It is also a prescription for conservative governance of the sort that has thrived since Ronald Reagan. Doing nothing is the easiest thing.

Since most people like the health care they have, the President has been forced to say, "If you like the health care you have, you can keep it." But it is difficult to enact substantive reforms when 80% of the system stays the same. The need for simplicity has also forced Obama to stick with — indeed, to double down on — the current practice of having employers provide health insurance. This is the weakest, most illogical part of the system. It is difficult to sustain in a global economy where American corporations have overseas competitors that aren't saddled with providing health care for their employees.

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