Health Reform Implementation 'Pickle'

At the Implementing Health Care Reform blog at the IBM Center for the Business of Government, Donald F. Kettl bluntly describes the magnitude of the challenge.

"We're in a real pickle," he writes.

The health reform effort, Kettl notes, is "one of the most dramatic policy initiatives that American government has ever tried." And not just because health care is such a major part of the American economy. What's even more ominous, he says, is that "we simply don't have the political institutions, administrative mechanisms, information systems, and learning systems in place to make it work."

Earlier this year, GovExec Editor at Large Timothy B. Clark noted that "history shows that major legislative and regulatory initiatives often are vulnerable to crippling change or even repeal in the aftermath of their adoption." He noted the work of Eric M. Patashnik, an associate professor at the University of Virginia and author of Reforms at Risk: What Happens After Major Policy Changes Are Enacted (Princeton University Press, 2008), who has argued that health reform implementation faces a series of potentially crippling challenges.

It may be going too far to say that the instutions of government are being set up to fail in implmenting health reform. But at the very least, as Kettl notes, agencies have a lot to learn--and fast.