As readers of this blog will have realized, we have been watching with keen interest the effort to reform the health care system in the United States in order to pull out generalizable lessons for reform efforts elsewhere. As you must also know, over the month of August that reform effort ran into some turbulence, with lively town-hall meetings, and the rise of a blocking coalition. The outcome remains in the balance as I write.
Now, other students of the process have offered one explanation of the current challenges faced by this particular reform effort. They say that much of the effort concentrated for a long time on the Inside Game, that is getting the United States Congress to act, and keeping the discussion within authoritative state institutions. According to these observers, reformers ignored the Outside Game...building a reform coalition within the broader society, and shaping public opinion. That supposedly gave opponents of reform the chance to build what they hope will be a blocking coalition, frame the reform effort negatively and so on. These observers believe that the Outside Game is now on, but some damage was done.