What Government Can Do

This chapter examines the obstacles to egalitarian policies for health care. One is the decentralized nature of American politics, characterized by separation of powers and federalism, which provides multiple veto points for stopping new programs. The second factor is a high degree of political inequality that enables small but active and affluent groups of individuals and corporations to prevent major egalitarian policy changes. The chapter also suggests that removing the obstacles to egalitarian programs is possible through four political strategies: (1) organize, particularly at the grass roots; (2) build incrementally toward long-term goals; (3) think big and seize opportunities when they arise; and (4) reform the political process itself.