Will Special Interests Stymie Health-Care Reform?

"Sometimes I get a little frustrated," Barack Obama admitted to AARP in late July, "because this is one of those situations where it's so obvious that the system we have isn't working well for too many people, and that we could just be doing better." He was talking about health care, of course. As Washington collapsed toward its August recess, the President's reform efforts were looking distinctly iffy, even though he is absolutely right about the need for change. The system is a fiscal mess, the king of all budget busters. It is also a moral mess, leaving far too many Americans with far too little protection. But the President is wrong when he says, "The system we have isn't working well for too many people." The vast majority — more than 80% in the latest TIME poll — are satisfied with their health care. They may be worried about losing their coverage, and angry as their premiums rise, but the health-care "crisis" is theoretical to most Americans. That's the immediate source of Obama's frustration, but there is a larger, structural issue blocking his path. (See the five biggest hurdles to health-care reform.)

One of the most difficult things to do in a democracy is react to a problem that is real, but not immediately threatening. Obama is trying to do this in two monster areas, health care and climate change. "He's killing me," says Senator Debbie Stabenow of Michigan, referring to the hordes of special-interest groups that have camped on her doorstep and clogged her phone lines. Stabenow is smiling as she says it. She supports the broad thrust of Obama's initiatives. "But you can't believe all the groups that want to make their case. There are the doctors, the nurses, the cancer society," she continues, raising the specter of a conga line of disease groups bending her ear. "All of them have legitimate concerns. And that's just health care."

As long ago as 1982, the economist Mancur Olson made the argument, in The Rise and Decline of Nations, that as a democracy matures, special interests grow more entrenched. Their intense dedication to their own specific needs, Olson wrote, often trumps the broader, but less focused, interests of society. And that was before the rise of cable news and talk radio. It was before the utterly corrupting effect of televised advertising on politicians really kicked in — the need to raise money (from interest groups, mostly) and to exercise extreme caution lest one of your votes be used to decapitate you in a 20-second ad. It was before the Democrats and Republicans transformed themselves into more strictly ideological parties. Put all these factors in the cauldron and you create a poisonous atmosphere that makes legislative action on big issues almost impossible. It is also a prescription for conservative governance of the sort that has thrived since Ronald Reagan. Doing nothing is the easiest thing. (Read TIME's exclusive health-care interview with Obama.)

"We've gotten rusty at legislating," says Representative Jim Cooper, a Tennessee Democrat. He is being kind. There are only two sorts of legislation that seem to pass these days: things that have to pass, like budgets — and cotton-candy giveaways, like tax cuts or the wildly irresponsible, unfunded Medicare drug bill that George W. Bush enacted. Occasionally, responsible actions take place in the budget process. Bill Clinton spent most of his political capital on deficit reduction, which helped fuel the economic boom of the 1990s. Obama has just managed to kill the F-22, an anachronistic fighter jet. Very, very occasionally a special interest will take it on the chin — as the teachers' unions did when Bush passed the No Child Left Behind Act, which mandated a testing regimen the teachers didn't like. But the passage of landmark legislation like the health-industry reforms that Obama is seeking has become about as common as politicians who refuse to run television ads. It just doesn't seem to happen anymore.

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