What's behind this?

Shannon Brownlee is perhaps a smarter and more reasonable version of Kevin Trudeau. Trudeau has made millions as the sultan of snake oil. He claims that doctors and the pharmaceutical industry are evil. Brownlee believes that medicine and treatment are good when administered sufficiently and necessarily. But she knows there are problems with the system. We all know that.

She was just on Book TV talking about her book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.

It was an interesting presentation. I wish I had started watching from the beginning. And I wish had been paying closer attention when one fellow in the crowd asked her a question (I think it was about managed care) and he relied on the premise that some part of the system "has always been behind the progressive 8-ball."

[Update: As Casey points out in his comment the program is now available. It must take some time before the video is posted on the C-SPAN website. I had looked at that page. Here's the full quote from the question (~45:50 into the video):

"Two topics: medical assistance in Maryland, and mental health. Medical assistance in Maryland has always been behind the progressive 8-ball. Have you done any looking into programs in other states...? What have you seen in other states that makes medical assistance models look good?"

And by medical assistance he means programs like Medicaid.]

I think he was trying to accomplish more than this image is accustomed to.

It makes sense that by saying its behind the 8-ball he means the system is in trouble. It finds itself stymied while facing an important task. Some people will throw in the word "proverbial" to make sure that we dense listeners catch the metaphorical intention.

They're playing snooker ol' boy?
No no. It's a proverbial 8-ball ol' chap
Ah. But of course!

Well since he was arguing for the importance of change I'm guessing that he meant the health care system is lagging in its response to the need for improvement and evolution. So the system is behind in its task of progress. And it's a tough situation. But instead of a proverbial 8-ball this is a progressive 8-ball.

So here we find it behind_blocked and behind_lagging.

So this blend seems to be functioning on the idea that "the 8-ball" is both a hindrance to progress and the model of progress. Awesome.

This looks like a wonderful instance of several necessary influences interacting at the right time to create this phrase. The standard term --proverbial-- being close enough to another word --progressive-- so that because of an implication of the argument (we need progress) an idiomatic blending occurs maybe even influenced by several other 'behind the X' phrases taken to be sports/gaming idioms even if they're not all from the world of sports.

Behind in the count
Behind the curve
Behind in points

And I've found a few sites that use the phrase "behind the curve ball" meaning running late or in a difficult situation. see here see here.

Apparently some people do see "behind the curve" as a baseball image.

(BTW: Within a span of only a few minutes I heard Brownlee use Isis formation a couple of times. Loverly.)