Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 17
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Leimbigler, Betsy and Lammert, Christian 2016. Why Health Care Reform Now? Strategic Framing and the Passage of Obamacare. Social Policy & Administration, Vol. 50, Issue. 4, p. 467.

    Jacobs, Alan M. and Weaver, R. Kent 2015. When Policies Undo Themselves: Self-Undermining Feedback as a Source of Policy Change. Governance, Vol. 28, Issue. 4, p. 441.

    Béland, Daniel Rocco, Philip and Waddan, Alex 2014. Implementing health care reform in the United States: Intergovernmental politics and the dilemmas of institutional design. Health Policy, Vol. 116, Issue. 1, p. 51.

    Fletcher, Jamie and Marriott, Jane 2014. Beyond the Market: The Role of Constitutions in Health Care System Convergence in the United States of America and the United Kingdom. The Journal of Law, Medicine & Ethics, Vol. 42, Issue. 4, p. 455.

    Hajnal, Zoltan L. and Horowitz, Jeremy D. 2014. Racial Winners and Losers in American Party Politics. Perspectives on Politics, Vol. 12, Issue. 01, p. 100.

    Franko, William W. 2013. Political Inequality and State Policy Adoption: Predatory Lending, Children's Health Care, and Minimum Wage. Poverty & Public Policy, Vol. 5, Issue. 1, p. 88.

    Haeder, Simon F. and Weimer, David L. 2013. You Can't Make Me Do It: State Implementation of Insurance Exchanges under the Affordable Care Act. Public Administration Review, Vol. 73, Issue. s1, p. S34.

    May, Peter J. and Jochim, Ashley E. 2013. Policy Regime Perspectives: Policies, Politics, and Governing. Policy Studies Journal, Vol. 41, Issue. 3, p. 426.

    Pillay, Timesh D. and Skordis-Worrall, Jolene 2013. South African health financing reform 2000–2010: Understanding the agenda-setting process. Health Policy, Vol. 109, Issue. 3, p. 321.

    Skidmore, Max J. 2013. “Bipartisanship” as a Detriment to Anti-Poverty Efforts: Some Contrarian Comments. Poverty & Public Policy, Vol. 5, Issue. 3, p. 282.

    White, Joseph 2013. Budget-makers and health care systems. Health Policy, Vol. 112, Issue. 3, p. 163.

    White, Joseph 2013. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care. Health Economics, Policy and Law, Vol. 8, Issue. 03, p. 289.

    Burgin, Eileen 2012. Congress, Health Care Reform, and Reconciliation. Congress & the Presidency, Vol. 39, Issue. 3, p. 270.

    Haeder, Simon F. 2012. Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences. Policy Studies Journal, Vol. 40, p. 65.

    Milkis, Sidney M. Rhodes, Jesse H. and Charnock, Emily J. 2012. What Happened to Post-Partisanship? Barack Obama and the New American Party System. Perspectives on Politics, Vol. 10, Issue. 01, p. 57.

    Rhodes, Jesse Hessler 2011. Progressive Policy Making in a Conservative Age? Civil Rights and the Politics of Federal Education Standards, Testing, and Accountability. Perspectives on Politics, Vol. 9, Issue. 03, p. 519.

    Gutmann, Amy and Thompson, Dennis 2010. The Mindsets of Political Compromise. Perspectives on Politics, Vol. 8, Issue. 04, p. 1125.


The Road to Somewhere: Why Health Reform Happened: Or Why Political Scientists Who Write about Public Policy Shouldn't Assume They Know How to Shape It

  • Jacob S. Hacker (a1)
  • DOI:
  • Published online: 23 August 2010

Why did comprehensive health care reform pass in 2010? Why did it take the form it did—a form that, while undeniably ambitious, was also more limited than many advocates wanted, than health policy precedents set abroad, and than the scale of the problems it tackled? And why was this legislation, despite its limits, the subject of such vigorous and sometimes vicious attacks? These are the questions I tackle in this essay, drawing not just on recent scholarship on American politics but also on the somewhat-improbable experience that I had as an active participant in this fierce and polarized debate. My conclusions have implications not only for how political scientists should understand what happened in 2009–10, but also for how they should understand American politics. In particular, the central puzzles raised by the health reform debate suggest why students of American politics should give public policy—what government does to shape people's lives—a more central place within their investigations. Political scientists often characterize politics as a game among undifferentiated competitors, played out largely through campaigns and elections, with policy treated mostly as an afterthought—at best, as a means of testing theories of electoral influence and legislative politics. The health care debate makes transparent the weaknesses of this approach. On a range of key matters at the core of the discipline—the role and influence of interest groups; the nature of partisan policy competition; the sources of elite polarization; the relationship between voters, activists, and elected officials; and more—the substance of public policy makes a big difference. Focusing on what government actually does has normative benefits, serving as a useful corrective to the tendency of political science to veer into discussions of matters deemed trivial by most of the world outside the academy. But more important, it has major analytical payoffs—and not merely for our understanding of the great health care debate of 2009–10.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Nancy J. Altman 2005. The Battle for Social Security: From FDR's Vision to Bush's Gamble. Hoboken, NJ: John Wiley.

John D. Griffin 2006. “Senate Apportionment as a Source of Political Inequality.” Legislative Studies Quarterly 31(3): 405432.

Jacob S. Hacker 2008b. “Putting Politics First.” Health Affairs 27(3): 718823.

Jacob S. Hacker 2009c. “Yes We Can? The Push for American Health Security.” Politics & Society 37(3): 332.

Keith Krehbiel . 1998. Pivotal Politics: A Theory of U.S. Lawmaking. Chicago: University of Chicago Press.

Matthew Levundusky . 2009. The Partisan Sort: How Liberals Became Democrats and Conservatives Became Republicans. Chicago: University of Chicago Press.

Brendan Nyhan . 2010. “Why the ‘Death Panel’ Myth Wouldn't Die: Misinformation in the Health Care Reform Debate.” The Forum. 8(1) Article 5.

Christopher J Truffer , Sean Keehan , Sheila Smith , Jonathan Cylus , Andrea Sisko , John A. Poisal , Joseph Lizonitz , and M. Kent Clemens . 2010. “Health Spending Projections Through 2019: The Recession's Impact Continues.” Health Affairs 29 (3): 522529.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Perspectives on Politics
  • ISSN: 1537-5927
  • EISSN: 1541-0986
  • URL: /core/journals/perspectives-on-politics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *