Throughout history we find countries, societies and cultures that decline or fail, seemingly unable to adapt to the circumstances where others thrive. Americans have always welcomed innovation in technology. And this has been central to much of our economic success. This is not so true of innovation in social institutions.
At the founding of our country many former social institutions were tossed out, including a rigid class system of named ranks, and royalty itself. Newly created institutions were numerous and included a bill of rights, a secular government, a metric currency, and the idea that all are created with equal political rights (though this had to be perfected slowly over decades).
The Civil War era gave another burst of social innovation, and not just the abolition of slavery and subsidizing companies to build a transcontinental railroad. The Homestead Act of 1862 provided free land to those willing to migrate, settle and work to make the land productive. The Morill Act of 1862 established land grant colleges. The National Academy of Sciences was created in 1863 to provide scientific analysis and advice to the government.
Other social institutions have displayed an amazing rigidity and resistance to change even when economically maladaptive. The U.S. adopted a metric currency and Thomas Jefferson argued for a thoroughgoing metric system but, curiously, the U.S. maintained a mix of non-metric weights and measures. Congress, however, promoted the use of the metric system and, in 1866, made it unlawful to refuse to deal in metric quantities. The U.S. Metric Board was established to encourage this. President Reagan disbanded and defunded this board in 1982. President George H.W. Bush again directed all government agencies to use the metric system — but we dawdle yet.
Our long-time back and forth over the metric system is a simple model, a paradigm, of what happens in other institutions that become rigid and unresponsive to the needs of people. The root cause is almost always the same — vested interests that have become entrenched. There is no better example of this, and none more important, than the continuing health care debate.
Our traditional health care system is not a system. It is a vast set of related endeavors that have grown like Topsy. It cannot be understood by how it functions but only through its history. You might think such a non-organization would not be highly resistant to change, but that would be to ignore the entrenched and powerful vested interests involved.
In 1962 Ronald Reagan, speaking for the AMA, declared if “this program” passes that, “you and I are going to spend our sunset years telling our children and our children’s children what it was once like in America when men were free.” The program he spoke of was the Medicare bill before Congress. His predicted outcome did not happen. Once Medicare was in place, the vast majority came to value it.
When President Obama followed through on his campaign promise to expand health insurance coverage to the many uninsured, he ran into entrenched vested interests. Had these not been there, “Medicare for all” would have been a simple solution. Due to bargaining, cajoling and compromising with vested interests in the health care and health insurance industries, the Affordable Care Act grew to 1,400 pages. Those who opposed the act now criticize it for being too ponderous.
This act was signed into law in 2010. Some features of this act are in place now: Insurers are prohibited from imposing lifetime dollar limits on essential benefits. Dependents (children) are permitted to remain on their parents’ insurance plan until their 26th birthday. Insurers are prohibited from excluding coverage due to pre-existing medical conditions. Insurers are prohibited from dropping coverage when policyholders get sick.
This coming January the major features come into play: Most Americans will have health insurance, California will have its health insurance exchanges set up, Medi-Cal will become part of an expanded Medicaid, and tax credits will aid low-income families with their coverage costs.
This means the general health status of Americans will improve, which, in turn, will benefit the economy and our society. It is progress but imperfect progress. Due to vested interests it has involved a series of compromises rather than a simpler system written on a clean slate. It is an example of incrementalism in policy-making and called by the British “muddling through.”
Muddling through is not characteristic of a young person or a young country. It is more like the elderly, whether person or country. This is as well as we can do with our present political stalemates. But we can all hope that future elections can put stalemate behind and we can act like a young country again.
Bob Williams is a Millville rancher and a retired UCLA professor. His e-mail address is email@example.com.
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