One of the classic justifications for democracy is that an accountable government will do a good job of looking after people's needs, because the voters will reward the incumbents if they do that. The present health care reform struggles cast some doubt on this theory. It turns out that government can very publicly make a lot of people a lot better off, and it will not be rewarded, and in fact may be punished.Koppelman's commenting on the gap between US community perceptions of risk regarding medical expenses and the grim reality, reflected in wariness about the shape of health reforms. Citing the author of study who warned that "Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country", Koppelman comments that
all those people who oppose health care reform because they like the coverage they’ve got really have no idea of the real dangers they face, because they have no idea what their insurance companies would really do to them if they got sick. ... The people who will most benefit from the consumer protections that Obama is advocating – those who will experience serious illness in the future – have no idea that they are benefiting, and so will not politically reward those who deliver the benefits.That is an echo of the argument by Cass Sunstein & Timur Kuran in 'Availability Cascades and Risk Regulation' in 51(4) Stanford Law Review (1999) 683-768 that
Most risk judgments rest on little, if any, personal investigation; they depend largely, if not wholly, on trust placed in the judgments of selected others.Those 'selected others' are likely to be (or use a public discourse shaped by) 'availability entrepreneurs', ie activists who manipulate the content of public discourse through provision of data and explanations of what that data means.
On a smaller scale we are seeing such shaping in Australian proposals to solve 'the health crisis' through federal funding of superclinics (presumably without the Geoffrey Edelsten grand piano and other bling) and establishment of a national preventative health authority. The latter appears set to disregard proposals for higher taxes on unhealthy foods, higher cigarette and alcohol taxes, phasing out television advertising of junk food to children, a ban on all remaining tobacco advertising and phasing out alcohol advertising during sporting events, given Nicola Roxon's comment in today's Sunday Age that
I am absolutely focused on how government action can leverage change within the community rather than pretending that a regulatory approach on its own will solve these quite complex social problems.It would appear that the lever isn't going to be very large, despite a commitment to "making smoking history"
