Agenda Elixirs, Presidential Power Pills, Congressional Remedies, and Political Science Nostrums: The Quest for Health Care Reform

• Author: John P. Burke
• DOI: http://doi.org/10.1111/j.1540-6210.2010.02312.x
• Published date: 01 January 2011
• Date: 01 January 2011

Retrospective

Essay

John P. Burke is a professor of political

science at the University of Vermont. He is

the author of eight books and more than 40

articles on presidential transitions, decision

making, and White House organization

and management. His most recent work is

on the history of national security decision

making and the role of National Security

Council advisor: Honest Broker? The

National Security Advisor and Presi-

dential Decision Making (Texas A&M

University Press, 2009).

E-mail: jpburke@uvm.edu

112 Public Administration Review • January | February 2011

legislative fate? Much of the book is devoted to the is-

sue of how “managed competition” came so quickly to

take center stage. It was a newcomer policy-wise (hard

to believe now, but true, as Hacker narrates). It proved

enticing. Single-payer proposals lost traction in the

debate; needless to say, a British-style national health

service never made it to the front burner. So, too, for

the various tax-credit approaches that Republicans

favored, although they would have a longer shelf life.

One key event, Hacker narrates,

was the election of Harris Wof-

ford over Richard  ornburgh

to  ll the vacant Senate seat

of the late John Heinz (R-PA)

in 1991. Wo ord, a former

civil rights advisor to John F.

Kennedy and president of Bryn

Mawr College, seemed to have

little traction initially against

the better-known former

governor and attorney general.

But there was one saving realization: his campaign

advisors—James Carville, most notably—recognized

that health care reform was one issue that polled well

among voters. Wo ord was prepared to address it, and

it contributed to his surprising 55 percent win over

 ornburgh. Furthermore, the media, particularly

the New York Times, as Hacker documents, heralded

the emphasis on health care as the key to Wo ord’s

victory. Whether the Times was correct in its elec-

toral analysis remains an open question; a declining

economy in 1991 also likely loomed large. But the net

result was that health care reform made its way back

onto the political agenda from the backwater in which

it had languished during the Reagan years.

For Hacker, the reemergence of health care reform is

a central element of the story.  e subsequent focus

on a “managed care” option is another. Here, propos-

als by Alain Enthoven (one of Robert McNamara’s

legendary “whiz kids” at the Pentagon and a Stanford

University business school economist), the “Jackson

Jacob S. Hacker,  e Road to Nowhere:  e Genesis

of President Clinton’s Plan for Health Security

(Princeton, NJ: Princeton University Press, 1997).

239 pp. $39.95 (cloth), ISBN: 9780691044236;

$31.95 (paper), ISBN: 9780691005287.

The recent health care reform legislation passed

by Congress and signed by the president on

March 23, 2010—the Patient Protection and

A ordable Care Act1—provides a timely opportunity

to look back at Jacob S. Hacker’s  e Road to Nowhere.

 e work, published in 1997,

was written while Hacker was

still a doctoral student in the

Political Science Department

at Yale (he is now, after a quick

rise through the ranks there, the

Stanley Resor Professor of Politi-

cal Science). More importantly,

as Hacker’s subtitle suggests,

the book o ers an interesting

and in-depth account of the

Bill Clinton administration’s 1993–94 health care

initiative, with special focus on how its particulars

developed and why it failed in the end. It stands alone

as a  ne piece of scholarship on the Clinton e ort,

but Hacker’s analysis deserves a revisit in light of the

passage of the 2010 bill.

 e work might be pro tably read—as I did—along

with a more recent volume,  e Heart of Power: Health

and Politics in the Oval O ce by David Blumenthal

and James A. Morone (2009).2 Blumenthal and Mo-

rone take in a broader sweep of the history of federal

health care reform, with individual chapters on policy

e or ts from Franklin D. Roosevelt through George

W. Bush.  eir analysis provides an illuminating his-

torical backdrop for those with further interest in this

policy area, and it is a recommended read.

Hacker, by contrast, takes a more a focused lens of

analysis: how did the details of the Clinton health

care proposal come to be, and how did that a ect its

Agenda Elixirs, Presidential Power Pills, Congressional

Remedies, and Political Science Nostrums:  e Quest

for Health Care Reform

Hindy Lauer Schachter, Editor

John P. Burke

University of Vermont

[Jacob S. Hacker’s  e Road

to Nowhere] stands alone as a

 ne piece of scholarship on the

Clinton e ort, but . . . deserves

a revisit in light of the passage

of the 2010 [Patient Protection

and A ordable Care Act].