ajfortin.com

In the summer 2008 issue of The Fletcher Forum of World Affairs, Robert Faris and Bruce Etling contend

that the Internet is transforming peer-to-peer relationships—the way citizens interact with one another—as well as the vertical relationships between citizens and government.

But, they argue

the Internet and digitally networked technologies are not as good at improving the relationships and processes among government institutions, in other words, the horizontal processes.

If we are to believe the observers that describe the transformational aspects of the Internet—and there is plenty of evidence to suggest that it is changing the way we interact with the world and form communities—why have we not seen more political change as a result?

This fundamental building block of democracy – establishing and maintaining governmental structures that limit the concentration of power – is conspicuously absent in the literature that describes the democratizing impact of the Internet. This is not entirely surprising: the most promising aspects of digital networks, such as dispersing power to the periphery and facilitating wider citizen action, do not as easily translate into improvements at the highest level of government. Effective democracy and good governance are built upon both vertical and horizontal processes.

And so, I would also add, is accessible, affordable and quality health care.

Patient-to-patient, doctor-to-doctor, activist-to-activist relationships, for example, are getting both broader and deeper in the call for health care reform. But how does the internet help bring our large corporate and government health care institutions closer to creating the kind of economic, technological and professional arrangements that strike the right political balance? How, in other words, should the health care system be governed and what is the role of the internet in answering that question? How can the internet help restrain – should I say it – unhealthy aggregations of public and private power in health care?

Money and power are still useful on the Internet and can be used to offset free expression and to shape public opinion.

To paraphrase Faris and Etling, the success of our health care reform resides in the strength and integrity of persistent governing institutions, both private and public, for which neither popular uprising, demonstrations, or even elections is a substitute.

(Thanks to the Internet and Democracy Project, Berkman Center for Internet & Society at Harvard University.)