Bottoms Up: A Toast to the Success of Health Care Collaboratives... What Can We Learn?

Document Type


Publication Date

January 2004


Although the United States system of governance has undoubtedly served us well since the days of the founding fathers, changing times nonetheless require innovation. Scholarly literature is rife with theoretical suggestions of just how to accomplish such innovation - methods that are of course touted as the cure-all to problems with international relations, homeland security, local governance, and democratic process, to name a few. This paper discusses the practical intersection of two particular lines of theoretical debate, both aimed at improving the structure of governance. One line of debate follows from the work of Michael Dorf and Charles Sabel in A Constitution of Democratic Experimentalism, published in the Columbia Law Review. Democratic experimentalism, as defined by Dorf and Sabel, is a mechanism of governance whereby citizens use local knowledge to solve local problems. The solutions are then shared across horizontal networks for maximum systemic benefit.The second line of debate concerns the use of public/private partnerships in governance, encompassing suggestions such as school vouchers and outsourcing traditional governmental tasks to the private sector. The common theme of turning government on its head (or at least on its side) runs throughout both debates, but what is lacking in most of the academic work in this area is concrete and tangible proof that the theories will work in practice and a discussion of the way the theories work in tandem. Through an analysis of a unique set of organizations called "Collaboratives," which are mostly dedicated to practical implementation of Congress's Health Insurance Portability and Accountability Act ("HIPAA"), this paper demonstrates the real, tangible application of both lines of governance innovation theories.The HIPAA Collaboratives have found success in their ability to bring a heightened level of innovation and efficiency to the game through use of a non-hierarchical structure characterized by public/private collaboration and the use of "soft law." By way of summation, this paper posits that the Collaboratives' method may hold the key to successful innovation in other important areas, such as world-wide governance of the Internet, stock exchanges, and financial markets; global intellectual property issues; and even seemingly distant fields such as education.