Small group reform politics and the real world: Cleveland's Council of Smaller Enterprises

The Clinton Administration's efforts at health care reform are somewhat hamstrung by a lack of working analogues, i.e., a scarcity of examples of what effective reforms might look like. While several excellent models of effective small group reform exist, the environment in which these living models operate and the tough decisions they have made to adapt to respond to the environment, have rendered them less than perfect. Rather than rely on these working models for guidance on both the promise and the limitations of health care reform, Administration officials appear to have chosen instead to highlight the models' inadequacies and discuss in a very general way how a government-based model might perform better. Instead of being guided by existing reality, government officials have chosen to attempt to reinvent it. The experience of one of the nation's largest and most successful purchasing cooperatives shows that workable reform will come not from broad vision or elegant models but from obsessive attention to the details in the real world.