Customer Reviews

The Road to Nowhere

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What Noam Chomsky is to politics, Jacob Hacker is to American Health Reform in the 1990s. In a concise and readable fashion, Hacker explains why universal health reforms started to spring up - almost form nowhere - to achieve major attention in the early 90s, only to recede into the periphery of political issues today.

Surprise, surprise, it has little to do with principles and everything to do with being a potential winning election issue. Hacker details in depth how Jim Carville and co. used the health issue to give Democratic Senate hopeful Harris Wofford a come-from-behind win, only to gravitate to then Governor Clinton's Presidential bid the following year with a similar strategy. The critical role of the New York Times editorial board in "agenda setting" the issue of "managed competition" (while simultaneously squelching more liberal options like a single payer system), is outlined in detail. What's most striking is Clinton's almost naive belief that, if he proffered a sufficiently "centrist" bill, Republicans would have to negotiate with him. The book clearly details the various actors and how they affected not only Clinton's thinking, but the range of "practical" health reform options.

If you read one book on US health policy, make it this one.

This is a terrific and very well-written history of the Clinton health plan debacle. It includes a good precis' of major features of American health policy over a decade or more leading to the Clinton election. One of the key features - and the author is quite explicit - the Clinton plan is used as a case study of how American healthcare politics and the American political agenda in general work. Therefore, it is not just "history" of 1993 - it remains highly insightful and relevant for all of us watching healthcare debates and agendas in 2006, 2007, 2008. If you've read this book, you'll have a lot of "aha" moments that would have escaped you otherwise. And having a perspective so rich through the 1990's gives you a frame of reference for a lot of articles and authors and issues writing right now - most of them lived through the past decade's issues and the decade before. Hacker's most recent book is "The Great Risk Shift" which has gotten good reviews. But "Road to Nowhere" should be better-known and more widely read than it is. The only weakness for me is that he tries to build to a careful analysis of diverse political reasons why the proposal failed - my own non-historian hunch is that a sudden 500-page mysterious bill labeled as developed in secret by "hillary clinton" upending the status quo, was enough to sink it without a dozen subtle collateral reasons....