For the first time since the early 1990s, the political environment in the United States offers the real possibility of fundamental reform of our fraying health care system. Although the current moment appears promising for reform, the opportunity could easily dissipate as it has in the past. In this paper, we offer seven observations on the key opportunities and pitfalls for health care reform advocates in this pivotal election year, based on our analysis of the current political dynamic and recent public opinion research. [Health Affairs
The use of public opinion polling in American politics has exploded in recent years. National candidates spend thousands of valuable campaign dollars on their own polls. Newspapers and television stations regularly conduct polls, as do networks and news magazines. The proliferation of polling raises fundamental questions about the role of the elected representative in democracy. But it also offers exciting opportunities for engaging American voters in direct debates on policy priorities and directions.
I would like to address the question of whether having consultants opens up or closes up the political system. I am principally interested in the election of women and minority candidates. I work now for a firm where half of our candidates are women, which is a very high proportion. On the one hand consultants reinforce incumbency because there is such a strong relationship between money and being able to hire a consultant. By the same token I think that consultants have opened up the process of running for election.Recruitment of CandidatesWhen everyone talks about the decline of parties that means there are alternative routes to power, there are alternative routes to the skills that you need to get elected, and there are alternative routes to information. This has caused a major breakdown in political machines. Consultants are also aware of the different traits that can make people electable. Consultants first understood that there are certain districts where women candidates run better than male candidates, where women start out ahead because of the demographics of those districts. That is something that a male-dominated machine, for example, might resist but a consultant would relish and approach pragmatically. You also see outsiders with personal resources who have the most access to an alternative way of entering the system. The Wisconsin Democratic Senate race is a prime example of what can happen when a candidate with tremendous personal resources can hire a team and become a front-runner against people who have been running and elected for a long time.
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