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140 U. Pa. L. Rev. 1923 (1991-1992)
Bias of American Politics: Rationing Health Care in a Weak State

handle is hein.journals/pnlr140 and id is 1941 raw text is: POLITICAL ACCOUNTABILITY THE BIAS OF AMERICAN POLITICS: RATIONING HEALTH CARE IN A WEAK STATE JAMES A. MORONEt Americans, we are often assured, do not like their government.1 The assertion is partially truth and partially myth. This Article offers a more detailed map of the American political processes, and applies it to the debate over rationing health care. Three forces shape our public policies: the first is a distinctive tendency to bash the state. The scope and intensity of anti- governmental ideology are exaggerated by a second feature of the American political landscape, the organization of our government. Fragmented, overlapping, often incoherent institutions blunt political action-more or less as the Founders intended.2 Thirdly, Americans are swift to mobilize politically. Interest groups, organized lobbies, and ad hoc action committees all find this government comparatively easy to influence. Taken together, ideology, institutions, and interests systematically bias our public policies and public debates toward the status quo. This bias of American politics shapes the paradoxical debate over health care rationing. The very notion of rationing alarms t Associate Professor of Political Science, Brown University. Author of DEMOCRATIC WISH: PRIVATE POWER AND THE LIMITS OF AMERICAN GOVERNMENT, which won the American Political Science Association's 1991 Gladys M. Kammerer award. Editor-in-Chief, JOURNAL OF HEALTH POLITICs, POLICY AND LAW. 1 See JAMES A. MORONE, THE DEMOCRATIC WISH: POPULAR PARTICIPATION AND THE LIMITS OF AMERICAN GOVERNMENT 2-5 (1990) (analyzing the American dread of government). 2 The point is often exaggerated, although The Federalist did call for ambition to counteract ambition. THE FEDERALIST No. 51, at 265 (Alexander Hamilton orJames Madison) (Max Beloff ed., 2d ed. 1987). The Federalists tirelessly repeated a new kind of administrative catechism: their government would operate with energy, vigor, firmness, steadiness, and decision. See THE FEDERALIST Nos. 17, 27, 68 (Alexander Hamilton), No. 46 (James Madison). For a discussion of the subsequent development of the administrative state from this perspective, see JOHN A. ROHR, To RUN A CONSTITUTION: THE LEGITIMACY OF THE ADMINISTRATIVE STATE (1986) (attempting to reconcile discourse of Constitution with contemporary administrative apparatus). See also MORONE, supra note 1, at 66-72 (discussing the Federalist's pursuit of an ambitious and energetic executive, both at the Constitutional Convention and during Washington's administration). (1923)