Basically, the current system is a local optimum for a large number of powerful interests. Also, the beneficiaries of a current system all are organized, while

Basically, the current system is a local optimum for a large number of powerful interests. Also, the beneficiaries of a current system all are organized, while the beneficiaries of some major reform are not organized, thus their lobbying power is greatly muted. If you're interested, I wrote a blog post where I lay out in detail why the politics of healthcare reform solves for complicated solutions: http://intellectual-detox.com/2009/09/10/the-perfect-healthcare-plan-and-why-well-never-get-it/ http://intellectual-detox.com/2009/09/10/the-perfect-healthc... I'd love to hear your thoughts. Also, I highly recommend "Government's End" by Jonathan Rauch which is the single best book to understand Washington. It talks a lot about this issue. The core problem is that the structure of our political system is fundamentally pro-entropy. Madison was completely wrong about factions. Unfortunately, the only way to defeat entropy is with concentrated authority. But that is anathema to the American ideology. So the entropy continues to increase unabated.