November 25th, 2014
On November 6, Larry Kramer, president of the William and Flora Hewlett Foundation in Menlo Park, California, spoke at the Grantmakers In Health (GIH) Fall Forum. He is a chief architect of Hewlett’s nascent Madison Initiative, which aspires to help restore room in Congress for the kind of negotiation and compromise that is necessary for members of Congress to act and solve problems. In the words of the foundation,
This requires that Congress represent and balance the diverse and often conflicting array of interests, ideas, and agendas of the American people; that the public believes in the legitimacy of the process through which Congress is working; and that the process can support the refinement and improvement of past decisions as new circumstances arise.
Coming just two days after the 2014 midterm elections, Kramer’s speech describing this ambitious goal was not only a timely topic, but also an opportunity for health funders to reflect at the broadest level on the political processes that ultimately shape health policy.
Congressional dysfunction, and the threat it poses to the integrity of the democratic process, is the impetus for the Madison Initiative. As Kramer described it, political dysfunction has become so extreme that moving policy at all—much less in a productive direction—is virtually impossible. The problem cuts across all fields and sectors and affects everyone. It is acutely evident in Congress, but there are also troubling signs that it is seeping downward to the local level. Because of this dysfunction, Kramer has previously observed in the Stanford Social Innovation Review blog, “Solving problems at scale has become nearly impossible now that political polarization has all but extinguished rational debate and smothered any ability to compromise.”
Kramer cited political reactions to the Affordable Care Act (ACA) as just one example of the dysfunction that the Madison Initiative will address. Other major policy reforms have been accepted at some point, even if they were controversial initially, he said. In contrast, in the current era, there continue to be calls for the repeal of the ACA, nearly five years after the law took effect.
What Is the Problem with the Democratic Process?