The Road to Nowhere

Duringthe1992presidentialcampaign,healthcarereformbecameahotissue,pavingthewayforoneofthemostimportantyetill-fatedsocialpolicyinitiativesinAmericanhistory:BillClinton's1993proposalforcomprehensivecoverageunder"managedcompetition."HereJacobHackernotonlyinvestigatesforthefirsttimehowmanagedcompetitionbecamethepresident'sreformframework,butalsoilluminateshowissuesandpoliciesemerge.HefollowsClinton'spolicyideasfromtheirinitialformulationbypolicyexpertsthroughtheirendorsementbymedicalindustryleadersandpoliticianstotheirinclusion-inanewandunexpectedform-intheproposalitself.Throughoutheexploreskeyquestions:Whydidhealthreformbecomeanationalissueinthe1990s?WhydidClintonchoosemanagedcompetitionovermorefamiliaroptionsduringthe1992presidentialcampaign?Whateffectdidthishaveonthefateofhisproposal?DrawingonrecordsofthePresident'staskforce,interviewswithawiderangeofkeypolicyplayers,andmanyothersources,Hackerlocateshisanalysiswithinthecontextofcurrentpoliticaltheoriesonagendasetting.HeconcludesthatClintonchosemanagedcompetitionpartlybecauseadvocatesinsideandoutsidethecampaignconvincedhimthatitrepresentedauniquemiddleroadtohealthcarereform.Thisconviction,Hackermaintains,blindedthepresidentandhisalliestothepoliticalrisksoftheapproachandhinderedthedevelopmentofaneffectivestrategyforenactingit.