The Neglected Conflict: Politics vs. Policy

The ongoing battle over health reform is largely perceived as a confrontation between Democrats and Republicans. Focusing on two parties obscures a very important fact that the battle is waged on two fronts—whether a reform law will pass, and what will be in a reform law. It’s a classic conflict between politics and policy, and it rages within the parties at least as much as between them.


Politics is the art of getting things done. Its practitioners focus predominantly on winning elections and retaining power. Politicians work diligently to deliver on promises they made as candidates, always with the next election in mind. Passing (or defeating) a law is the ultimate measure of their success in politics. For health reform in 2009, Democratic leaders were much more concerned with rushing a bill to the President’s desk than they were with the bill’s content. They argued that the law’s flaws could be addressed in 2010 and beyond.

By contrast, policy is the science of creating purposeful change. It involves defining a desired future state and a viable way to get there. Policy makers analyze data and evaluate impact of actions that might move the numbers in the desired direction. They are inclined to take the time needed to put together a package that makes sense for their constituency. They aspire to “get it right” the first time so that a resulting law will not need to be amended in the next legislative session.

Sadly, from my perspective, politics trumped policy during the 2009 confrontation over health reform. Long-overdue policy changes fell by the wayside as political deals were made to secure votes. Getting a law passed was more important than passing a good law—and all sides lost when all was said and done. Consequently, my forecast for legislated health reform any time soon has slipped to 10%. (See my December 2009 blogs for details on the previous forecasts.)

Good policies that slipped from the pinnacle of reform to the purgatory of demonstration projects over the course of 2009 are unlikely to be enacted any time soon. However, the critical state of health care in the U.S. does not allow complacency. We’ve got an impending disaster on our hands if we don’t make needed changes, and it looks like we’ve got to make them without a reform law. We must resurrect and implement good policy proposals outside the political realm.

In your opinion, which reform policies need to be pursued ASAP? How would you proceed to get them implemented? (For my views, see previous posts to this blog and recent writings at www.jeffbauerphd.com/writing.htm. To express yours, click on Comments just above the title of this post.)