Trias Politica

“What Happened to Health Care Reform?” This is the question Paul Starr (2001) asked after President Clinton was forced to abandon his attempt to reform the nation’s flailing health care system. As Starr (2001), a member of Clinton’s White House health policy team, observed, “it was one year from euphoria to defeat.” Like Starr, many historians still struggle to understand why this moment was lost. Why was health care reform, more than half a century in the making and so desperately needed, not achieved? Was it the fault of Republicans, moderate Democrats, key interest groups, mismanagement by the President and his team as Paul Starr (2001) speculates in his article? Or was something else at play? Interestingly, what Starr and most historians omit from their imposing list of potential culprits is the main malefactor—Madisonian government. Whatever the merits of the Madisonian system at the nation’s founding—and there are many—health care is but one example of a problem in modern American life that not only went unaddressed for far too long but has been made worse by our institutional design.