If you would believe the latest rumor, President Obama allowed $50 billion in earmarks attached to the stimulus bill to go deliberately unchallenged by his administration. The reason why, as the story goes, is that these pork barrel tack-ons were a de facto bribe/concession made to prominent lawmakers the Chief Executive needs on board to pass the more ambitious parts of his agenda. Since Obama has proven himself a shrewd politician, I wouldn't be surprised if this story has some truth to it. Establishing a universal health care system will require every vote and every friend the President can muster.
Even a casual observer of the democratic process knows it is a frequently messy affair. For example, one could take into account health care for the poor and the elderly. The Medicare/Medicaid divide, itself a part of another ambitious Democratic president's agenda, is an example of the kind of rough compromise that proves to be infuriatingly insufficient and wholly unsatisfying in the end. That is to say, Medicare is a completely federal agency, while Medicaid is a federally mandated, but state-run program whose efficiency is often directly proportional to the amount of tax revenue the state in question accrues. Wealthier states have effective Medicaid programs, while poorer ones often suffer in contrast. Though the first bailout bill contained a provision to establish parity between the two programs, which might help fix this gap in quality of care, I fully expect to see these sorts of problems in whichever bill seeks to give basic health services to the 48 million Americans who currently do not have health insurance at all.
Part of the problem comes down to the nature of needless complication and government inefficiency. The intent of these programs is not in question---rather it's the implementation. Each bureau has its own nomenclature, jargon, and unique buzz words. Many related agencies barely know how to talk to each other and if they do, the concentric circles of layer upon layer of hierarchy make reaching out to other related agencies a clumsy affair. Much of this is because people frequently love to be the masters of their own self-sustaining, self-perpetuating, important-sounding kingdom. I happen to know people in these hyper-specific fields who get downright indignant if one implies that their beautifully-written grant proposal or fiduciary statement does little to help the underprivileged people who need their basic social services the most. The analogy I like to use is that it's well and good to ask someone to read War and Peace until one recognizes, of course, if they haven't had the opportunity to even learn what the letters A, B, and C mean, there's no way they'll be able to understand the complexities of an already over-complex system.
In the meantime, I'll try to ignore the alarmist headlines thrown out by the media, each of which implies that every piece of legislation offered by the Obama Administration is on the verge of hitting some impossible impasse, and realize instead that while something will get passed, eventually, it will be imperfect and in need of immediate reform. Whatever does get signed into law--be it health care reform, a new policy towards Cuba, or even the most inane esoterica will be inexact and full of the kind of half-measures and irrationality that always result from a federal system comprised of fifty states each with their own internal agendas.