The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security(Princeton Studies in American Politics)

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.

Table of Contents:
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

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.

Review :
Co-Winner of the 1997 Louis Brownlow Book Award, National Academy of Public Administration "Mr. Hacker brings commendable clarity to a subject that has usually encouraged jargon and convolution."--David Greenberg, The New York Times Book Review "Hacker's assessment is measured and balanced... This book will be read by two audiences: those who are interested in health policy per se and those who are interested in the policymaking process. It is equally instructive for both."--Mary E. Guy, American Political Science Review "As an intellectual history, his narrative is unrivaled... Hacker's book raises many provocative questions ... and it is for that reason that it is immensely valuable."--Flint J. Wainess, Journal of Health Politics, Policy and Law "[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