Publicity-Stunt Participation and Sound Bite Polemics: The Health Care Debate 1993–94

The outcome of Bill Clinton's health care initiative presents policy analysts and democratic theorists with a puzzle: How could vigorous discussion of health reform, introduced into the context of an emerging public consensus about its urgency, produce widespread incomprehension of the issue and foster public reluctance to embrace any specific proposal for change? Starting from the perspective of political theories of deliberative democracy, I approach the puzzle of failed health reform by pointing to the paradox of decision making in an adversary democracy. First, I argue that the policy initiative stalled because the debate was set up to depoliticize the question of health reform and thereby disengage citizens from the problem. Second, I defend a conception of "power-sensitive" deliberation, which I argue is a check against two typical mechanisms of depoliticization: factionalism and the "democractic wish." Third, I suggest four criteria for power-sensitive deliberation, which I then use to analyze the recent health care debates. Finally, I explore the incentives and obstacles to creating opportunities for this kind of deliberation.