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The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security

The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security

by Jacob S. Hacker

Paperback(Revised ed.)

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During the 1992 presidential campaign, health care reform became a hot issue, paving the way for one of the most important yet ill-fated social policy initiatives in American history: Bill Clinton's 1993 proposal for comprehensive coverage under "managed competition." Here Jacob Hacker not only investigates for the first time how managed competition became the president's reform framework, but also illuminates how issues and policies emerge. He follows Clinton's policy ideas from their initial formulation by policy experts through their endorsement by medical industry leaders and politicians to their inclusion—in a new and unexpected form—in the proposal itself. Throughout he explores key questions: Why did health reform become a national issue in the 1990s? Why did Clinton choose managed competition over more familiar options during the 1992 presidential campaign? What effect did this have on the fate of his proposal?

Drawing on records of the President's task force, interviews with a wide range of key policy players, and many other sources, Hacker locates his analysis within the context of current political theories on agenda setting. He concludes that Clinton chose managed competition partly because advocates inside and outside the campaign convinced him that it represented a unique middle road to health care reform. This conviction, Hacker maintains, blinded the president and his allies to the political risks of the approach and hindered the development of an effective strategy for enacting it.

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Product Details

ISBN-13: 9780691005287
Publisher: Princeton University Press
Publication date: 03/28/1999
Series: Princeton Studies in American Politics: Historical, International, and Comparative Perspectives , #58
Edition description: Revised ed.
Pages: 256
Product dimensions: 6.00(w) x 9.25(h) x (d)

About the Author

Jacob S. Hacker is a Guest Scholar in Governmental Studies at the Brookings Institution, a doctoral candidate in political science at Yale University, and a Robert M. Leylan Fellow in Social Sciences at Yale University.

Table of Contents


Preface ix

Introduction: The Puzzle 3

Chapter 1. The Rise of Reform 10

Things Fall Apart 12

The Middle Class and National Health Care Reform 16

Media Coverage of Health Care Reform 20

Health Care Reform and the Congressional Agenda 23

Momentum toward Reform in Congress 27

The Impact of the Pennsylvania Election 31

Conclusion 40

Chapter 2. A Prescription for Reform 42

The Influx of Economists into Health Policy Analysis 42

The Neoclassical Critique 45

The Consumer Choice Health Plan and Its Critics 47

A Consumer Choice Health Plan for the 1990s 51

The Birth of the Jackson Hole Group 52

Framing the Jackson Hole Proposal 56

Drafting the Jackson Hole Proposal 60

The Advocacy of the New York Times 63

The Support of Conservative Democrats 67

The President's "Comprehensive Health Care Reform Program" 71

Conclusion 72

Chapter 3. The Liberal Synthesis 76

Liberals and the Long Struggle for Reform 77

From National Health Insurance to Single Payer 82

Health USA and the Liberal Adaptation 87

The Garamendi Plan and the Liberal Synthesis 90

Paul Starr and the Liberal Compromise 95

Conclusion 97

Chapter 4. The Campaign 100

The Early Campaign 101

The Politics of Ambiguity 104

The Politics of Discovery 108

Conclusion 116

Chapter 5. The Plan 117

The Presidential Transition 119

The Task Force 122

Politics, Pressure, and the Plan 129

The Public Campaign 138

Unveiling the Plan 142

Conclusion 149

Conclusion 152

Power and the Public Agenda 153

Ideas and Policy Communities 155

Leadership and Political Innovation 160

The Jackson Hole Proposal and the Rise of a Credible Alternative 162

The Liberal Synthesis 165

The Clinton Plan 166

The Failure of Reform 170

The Promise and the Limits of American Politics 180

Appendix A. Methodology 183

Appendix B. Jackson Hole Participants, 1990-1992 186

Appendix C. California Insurance Commissioner's Health Care Advisory Committee 189

Notes 191

Index 229

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