Citizen Politics: Breaking the Iron Cage

Citizen Politics: Breaking the Iron Cage

The Clinton administration has served the nation well by insisting upon the need for reform in our health system. But to date the debate reflects the dynamic described by Max Weber, through which a spreading pattern of technical rationality and expert-client relationships has hollowed out the civic culture of everyday life. If the conversation remains a technical one about what we get and how, concerned only with access, financing mechanisms, and cost containment, most people will be cast as consumers whose “power” consists of individual market choices. Given the huge vested interests of the health system, this will not generate the political energy necessary for major reform. The question is how to renew civic spirit.

Today’s health system reflects the rise of specialized knowledge as the basic currency of public problem solving. Health care has been shaped by broad patterns of urbanization, the growth of the corporate economy, and the development of mass communications systems, all of which have undermined communal authorities and popular self-confidence about citizens’ role in public affairs. Though they may actively demand solutions and services, most Americans also look to large systems and professional experts to provide them; they rarely see themselves as responsible, creative actors in any policy setting.

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