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Can the U.S. still tackle big problems? Lessons from the health-care battle.

Has our 234-year experiment with democracy failed in a fit of partisanship? William Eggers and John O'Leary revisit major U.S. government initiatives since World War II to assess what it takes to get things done.

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By William D. Eggers and John O'Leary
Sunday, March 21, 2010

At the height of the debate over health care last month, Vice President Biden put into simple terms a feeling that has become pervasive across America. "Washington, right now, is broken," he said.

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This from a nation that won World War II, split the atom and, yes, even put a few guys on the moon. For years, Washington has been shooting at some big targets -- fighting the wars in Iraq and Afghanistan, dealing with the aftermath of Hurricane Katrina, reforming immigration policy -- and too often missing the mark. And the arduous health-care reform effort, with its year-long debate, recriminations and dividing lines, only seems to prove how fraught and complex it has become for America to tackle ambitious tasks.

Some blame the red team, others blame the blue team. But most blame "the system," as though our 234-year-old experiment with representative democracy has failed in a fit of partisanship and dashed expectations. "Our government is old and broken and dysfunctional, and may even be beyond repair," wrote the Atlantic's James Fallows, in a typical lament. And in a radio address last fall, even President Obama felt compelled to reassure us that "we can still do big things in America."

The problem is not our system. By design, democracy is slow to change course; new ideas always face a lengthy struggle. Rather, the problem is that the ways in which we have come to use this system -- how we develop ideas, test them and put them into action -- need repair.

We've studied more than 75 major U.S. government initiatives since World War II, looking for patterns and lessons, and in so doing have explored great successes and monumental failures. We wanted to understand how the same country that launched the Manhattan Project could imagine that "Whip Inflation Now" buttons would curb rising prices, why the nation that rescued war-torn Europe could fail to rescue New Orleans and the Gulf Coast.

Although there are lots of ways that even well-intentioned projects can go awry, we found that successful initiatives tend to get some key elements right. We offer five simple principles that, if followed, could help renew America's ability to accomplish big things.

Capitalize on disagreement.

Bad ideas generally become reality when they aren't exposed to external criticism, when they emerge from the echo chamber of a small group of like-minded advocates. (Think of the introduction of "new math" teaching methods or the run-up to the latest Iraq war.) Significant successes, on the other hand, generally occur when leaders cross boundaries of ideology and expertise to exchange ideas with those who see the world differently.

For example, President Bill Clinton worked with a Republican Congress to enact welfare reform in 1996 -- resulting in plummeting caseloads. In Massachusetts, Mitt Romney and a Democratic legislature used market-based initiatives to expand health coverage to 97 percent of the state's population -- and provided national reformers with a preview of the benefits and drawbacks of their approach.

Openness to different perspectives creates a mash-up of ideas from unrelated fields and can produce new solutions to old problems. In the 1980s, for example, the battle over how to deal with acid rain was stuck in a logjam between corporate interests and environmentalists. Sens. Jack Heinz and Tim Wirth, a Republican and a Democrat, worked together on an emission-trading scheme based on "free market environmentalism." The result: a cap-and-trade approach that was one of the most successful environmental programs of all time, cutting sulfur dioxide emissions by 40 percent in the United States without crippling business. The key is to break free of bias by inviting new voices into the idea-generation process early on.

Design for the real world -- not just for Congress.

As the health-care battle has shown, the imperatives of the legislative process often seem to trump all else, resulting in bills that can pass Congress but that might not work in practice. The No Child Left Behind Act of 2001, the immigration reform of 1986 and the Freedom to Farm Act of 1996 all suffered from this trap, which we call "design-free design." All passed with healthy bipartisan majorities, and all had results so disappointing that politicians soon found themselves going back to the drawing board.

Avoiding this problem begins by realizing that it's far better to replicate an approach that has already proved itself in the real world than to launch an entirely novel solution. For example, welfare reform succeeded in part because Congress had the luxury of learning from innovative approaches in Wisconsin, Oregon and elsewhere. "We had a lot of evidence about what would work," explained Ron Haskins, who was the senior congressional staffer who wrote the legislation. "Many states had demonstration programs before we wrote the bill. We just rode the wave."

This principle also worked during the current Iraq war: The Pentagon and the Bush administration could have greater confidence in the troop surge of 2007 because it replicated a strategy that had proved itself in Anbar province.


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