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The Road to Nowhere Paperback – March 8, 1999
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"Mr. Hacker brings commendable clarity to a subject that has usually encouraged jargon and convolution."---David Greenberg, The New York Times Book Review
"Co-Winner of the 1997 Louis Brownlow Book Award, National Academy of Public Administration"
"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
About the Author
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Hacker presents the relatively sudden prominence of health care as a major issue as the convergent result of several semi-independent trends. Rising health care access problems provoked distress among middle-class voters with general economic anxieties. At the same time, costs were an increasingly concern for many corporations. A number of policy analysts had developed potential approaches to address these problems. Managed competition, to a large extent the brainchild of economist Alain Enthoven, emerged as the proposed solution of an influential group supported by major health insurers. Hacker lays out a series of contingent events, such as the unexpected election of the liberal Democrat Harris Wofford to a Pennsylvania Senate seat and the persistent interest of the New York Times editorial board that advanced health care to a front row concern and managed competition as a likely solution. A variety of similar contingent factor led to the adoption of the managed care approach as the preferred option for the Clinton campaign and administration. As Hacker shows, this approach had broad appeal but rather shallow support and the Clinton administration's efforts to implement it essentially ignored the political bargaining needed to implement a health care reform.
The most interesting parts of the book are Hacker's careful descriptions and thoughtful analyses of the different potential solutions advanced to address the dual problem of diminishing health care access and rising costs. This seems to me to be a fairhanded survey of the different options across the poltical spectrum. It will strike many readers that almost all these proposals were kludges trying to reconcile universal health care with the limits of the Ameican political system. The lineage of the present Affordable Care Act system is clearly visible in Hacker's descriptions. This is true both for many of the specific featurs of teh ACA and its basic position as an incremental reform falling considerably short of offering universal care.
Hacker is a clear writer and this book is largely free of the jargon that often characterizes political science work.