That progressives want to keep finding new areas for the government to get involved in (healthcare for example) is a misguided effort. It's based on the notion that government can always do things better and in a more compassionate way than any other delivery mechanism that exists. But if it is possible that government does something worse than the private sector or charities or some other mechanism does, then the government is harming the effort to help the poor or whatever other objective progressives have in mind when they call for government involvement in an issue. If that's the case in some circumstances, then progressives, wedded to the idea that government must be the solution, are misguided in their attempts at compassion. Government is not the solution for everything.
During the 2008 campaign, Obama in a debate with McCain is remembered for using this metaphor:
LOS ANGELES (MarketWatch) -- Sen. John McCain proposed a possible spending freeze on virtually every federal program except the Department of Defense, for veterans and entitlement programs in a presidential debate with rival Barack Obama Friday night. Obama countered that approach is too broad-based, saying it was the equivalent of "using a hatchet where you need a scalpel."
The quote while ridiculous in the context Obama used it, is actually quite apt when it comes to government. The problem with government is that it is really, really big. It is so big, that it isn't capable of being a scalpel when a scalpel is necessary, it's only capable of being a hatchet. And a hatchet is not the tool to fix every problem. Sometimes it's a scalpel and sometimes its a torque-wrench.
One of the governing ideas regarding governance that has driven much of my political philosophy has been that big does not mean efficient (it's not the only governing idea, but it is one of the key ones). As the government continues to grow, it continues to remove itself from the realm of the efficient in many arenas. The government growing itself into irrelevance would be a great and ironic long term solution to the problem of over-governance if the cost to the country in terms of more than just dollars, were not so steep.
Bureaucracy continues to expand and with it efficiency declines. It's the organizational equivalent of the Peter Principle. Governments can grow beyond their ability to govern effectively (or even fairly). In fact they routinely do so. The Soviet Union provides the penultimate example of this. China may yet do the same. So why would anyone think the U.S. government is immune. Being aligned with liberty and justice for all does not ensure competence.
It is important to note that the idea does not just apply to government. Often corporations and charities suffer the same problem - they become too big and either die or have to re-invent themselves in order to survive. Corporate examples abound; from Blackberry to Circuit City, Best Buy, General Motors and AIG to AT&T. But charitable organizations can have the same issue. The United Way ran into trouble more than once. The Catholic Church grew so large it became a repository for scandals, including ineffective tracking and management of its finances. The point is that it can happen anywhere and to any organization.
The mechanism for correcting private institutions be it corporations or charitable organizations is the free market. Get it right and they thrive, get it wrong and they perish. The mandate is clear. Government it has been argued is answerable to voters and that is the mechanism by which it is forced to remain efficient and effective. No one on the left or right would argue that the government is either efficient or effective in all things, though the left may argue that it is the most effective and most 'fair' way to do things.
Granted, governments can do things, even some big things well. The U.S. military has proven to be extremely effective in its role. The Apollo program was a fantastic achievement that could not have been accomplished in the same time frame by the private sector. But it cannot always do everything well - the U.S. Postal Service is an example of something once done well that is being squeezed out by innovation and competition and is now an albatross around the neck of the U.S. government.
The frame of reference for progressives when discussing options to solving problems has always been to move individual responsibility to a bigger, central mechanism. Sometimes that works, but sometimes it does not, and that is the likely sticking point in many debates because progressives refuse to believe that anything effective, or fair must come from government. Perhaps that should be the focus of future debate.