The Road to Nowhere

"[Hacker] is particularly adept at showing how top policymakers used the media to sell ideas, not just to the public, but to each other.... A fascinating portrait."---Julian E. Zelizer, Reviews in American History

Autorentext
Jacob S. Hacker

Klappentext
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.

Inhalt
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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