The ethical imperative that government heed the opinion of the public has its origins, thus, in democratic ideology as well as in the practical necessity that governments obtain the support of influential elements in society. ( Key 1961, 4)
Americans are deeply ambivalent toward reforming government involvement in health care: they are simultaneously supportive of significant reform and uneasy about expanding the government's role. ( Jacobs 1993, 629)
Democracy is a Greek word meaning rule by the people. It means that government operates on the basis of consent of the governed and the governed have some role in making decisions. The original form of democracy, direct democracy, began with the ancient Greek city-states, such as Athens. Citizens would meet and vote on policy decisions ( Hudson 1995). In the United States, New England town meetings and Congregational churches, both dating back to colonial times, embodied direct democracy. Voting mechanisms, such as the initiative and the referendum, developed during the Progressive era in the early years of the twentieth century, are more current forms of direct democracy. One important implication of the idea of democracy is that the majority of the people should be able to have its way.
The United States, however, is not a direct democracy. Despite the existence of the initiative and referendum, the system created by the Founding Fathers in 1787 made clear efforts to limit democracy as they understood it. Their understanding of democracy was the direct form: the people themselves should rule. But the Founders were largely fearful that such a political system would not last long and did not trust the judgment of the common person. They were particularly concerned about what they saw as the irresponsible behavior of the state legislatures as being overly responsive to the wants of the people and not the needs of the political system and the economy ( Dye and Zeigler 1987; Hudson 1995). They were also distressed by the weakness of the national government set up by the Articles of