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.