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I'm about to travel to Helsinki to discuss freedom of the press with a couple of excellent and eminent Chinese journalists. So I've been thinking a lot about the question of progress towards democracy in East Asia and whether or not it's really happening, or whether it's actually something else that's happening. And on this anniversary of the crushing of pro-democracy protests in Tiananmen 20 years ago, it seems apt to talk about what's happening with Medicare.
Wha...? Bear with me. Ezra Klein and a number of others have been talking recently about an Obama administration initiative to take Medicare policy-making away from Congress and give it to MedPAC, basically a technocratic commission that's been around making smart recommendations for more than a decade but has no power to implement the changes it recommends. In his initial post on the subject, Klein wrote this:
"Medicare payment policy is too technical for the Congress. There aren't five senators with an informed opinion on the ‘equipment use standard’ for imaging machines, much less 50, and much less 100."
That's undoubtedly true. More generally, health care policy is one of any number of areas in the U.S. where urgently needed policy changes are being paralyzed by ... well, basically, by democracy. When Asians of a certain ideological cast say they don't want multiparty representative democracy, or don't want "too much" multiparty democracy, and so forth, this is exactly the argument they use. How can legislators be expected to understand complicated regulatory issues thoroughly? How can the public be expected to understand them at all? Why should we set policy by empowering political demagogues to form parties that struggle over power using different policy positions as cheap rhetorical weapons? Can this really be the best way to chart the course of government? Doesn't policy and governance wind up overwhelmed by the vicious, noisy, potentially violent struggle for power? Or paralyzed by factional warfare?
The MedPAC proposal, the increasing importance of the Federal Reserve in making and implementing economic policy, the looming bankruptcy of California due to populist referendums and political polarization, the abdication of Congress from questions of national "defense" and war-making, the apparent political impossibility of cutting carbon emissions enough to avoid climatological disaster ... all of these are evidence that governance in the 21st century is posing problems that electoral democracy is hard-pressed to solve. When Asians think about multiparty competitive democracy, they may increasingly draw a contrast not between the U.S. and the U.S.S.R. — the contrast still assumed by many Americans — but between, say, China and Thailand. The challenge posed by the success of technocratic elite governance in China and Singapore is the possibility that government in the current era may increasingly demand not more democracy, but less.
It's possible that this thesis is completely wrong. Perhaps it's still true that responsibility towards one's citizens through multiparty elections is the best or only guarantee of good governance. But then again, maybe not. So that's what I'm thinking about as I head to Helsinki.