Jacob S. Hacker

Privatizing Risk without Privatizing the Welfare State: The Hidden Politics of Social Policy Retrenchment in the United States

Over the last decade, students of the welfare state have produced an impressive body of research on retrenchment, the dominant thrust of which is that remarkably few welfare states have experienced fundamental shifts. This article questions this now-conventional wisdom by reconsidering the post-1970s trajectory of the American welfare state, long considered the quintessential case of social policy stability. I demonstrate that although most programs have indeed resisted retrenchment, U.S. social policy has also offered increasingly incomplete risk protection in an era of dramatic social change. Although some of this disjuncture is inadvertent—an unintended consequence of the very political stickiness that has stymied retrenchment—I argue that the declining scope of risk protection also reflects deliberate and theoretically explicable strategies of reform adopted by welfare state opponents in the face of popular and change-resistant policies, a finding that has significant implications for the study of institutional change more broadly.

Winner-Take-All Politics: Public Policy, Political Organization, and the Precipitous Rise of Top Incomes in the United States*

The dramatic rise in inequality in the United States over the past generation has occasioned considerable attention from economists, but strikingly little from students of American politics. This has started to change: in recent years, a small but growing body of political science research on rising inequality has challenged standard economic accounts that emphasize apolitical processes of economic change. For all the sophistication of this new scholarship, however, it too fails to provide a compelling account of the political sources and effects of rising inequality. In particular, these studies share with dominant economic accounts three weaknesses: (1) they downplay the distinctive feature of American inequality —namely, the extreme concentration of income gains at the top of the economic ladder; (2) they miss the profound role of government policy in creating this “winner-take-all” pattern; and (3) they give little attention or weight to the dramatic long-term transformation of the organizational landscape of American politics that lies behind these changes in policy. These weaknesses are interrelated, stemming ultimately from a conception of politics that emphasizes the sway (or lack thereof) of the “median voter” in electoral politics, rather than the influence of organized interests in the process of policy making. A perspective centered on organizational and policy change —one that identifies the major policy shifts that have bolstered the economic standing of those at the top and then links those shifts to concrete organizational efforts by resourceful private interests —fares much better at explaining why the American political economy has become distinctively winner-take-all.

Business Power and Social Policy: Employers and the Formation of the American Welfare State

A number of scholars have highlighted the role of employers in shaping the development of the welfare state. Yet the results of this research have often been ambiguous or disputed because of insufficient attention to theoretical, conceptual, and methodological problems in the study of political influence. This article considers three of these problems in turn: the failure to distinguish and investigate multiple mechanisms of exercising influence, the misspecification of preferences, and the inference of influence from ex post correlation between actor preferences and outcomes. We demonstrate the importance of each through a reexamination of the early development of the American welfare state. The striking feature we suggest is neither business dominance nor weakness but marked variation in influence over time and across institutional settings.

The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and U.S. Medical Policy

Government-sponsored health insurance is a central pillar of the modern welfare state. In advanced industrial democracies, public spending on medical care accounts for an average of 6 percent of gross domestic product (GDP), making it the largest category of social spending after public pensions. Computed from Organization for Economic Cooperation and Development, The Reform of Health Care Systems: A Review of Seventeen OECD Countries (Paris: Organization for Economic Cooperation and Development, 1994), 38. The comparison with pensions is made by Karl Hinrichs, “The Impact of German Health Insurance Reforms on Redistribution and the Culture of Solidarity,” Journal of Health Politics, Policy and Law 20 (1996): 653–87. Despite the popularity and resilience of established health programs, however, the introduction of government-sponsored health coverage has been highly controversial everywhere. Few social programs involve the state so directly in the workings of the economy and the practice of a powerful profession. Few entangle the interests of so many diverse and resourceful groups. And few cast in such stark relief the ideological principles at stake. Although the participants in conflicts over health policy have differed from nation to nation, no country has acquired national health insurance without a fierce and bitter political fight.

Insecure Alliances: Risk, inequality, and support for the Welfare State

Popular support for the welfare state varies greatly across nations and policy domains. We argue that these variations—vital to understanding the politics of the welfare state—reflect in part the degree to which economic disadvantage (low income) and economic insecurity (high risk) are correlated. When the disadvantaged and insecure are mostly one and the same, the base of popular support for the welfare state is narrow. When the disadvantaged and insecure represent two distinct groups, popular support is broader and opinion less polarized. We test these predictions both across nations within a single policy area (unemployment insurance) and across policy domains within a single polity (the United States, using a new survey). Results are consistent with our predictions and are robust to myriad controls and specifications. When disadvantage and insecurity are more correlated, the welfare state is more contested.

Review Article: Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform

This article examines the recent pattern and progress of health care reform in affluent democracies, focusing in particular on Britain, Canada, Germany, the Netherlands and the United States. Its main contention is that efforts to reform health care in advanced industrial states have been marked by a paradoxical pattern of ‘reform without change and change without reform’, in which large-scale structural reforms have had surprisingly modest effects yet major ground-level shifts have, nonetheless, frequently occurred as a result of decentralized adjustments to cost control. The main task of the article is to investigate the reasons for and effects of this puzzling pattern by plumbing the largely unexplored theoretical territory between comparative health policy analysis and cross-national research on the welfare state. Along the way, the article develops a simple model of the politics of reform that helps explain cross-national variation in legislative and policy outcomes – particularly outcomes that occur through decentralized processes of internal policy ‘conversion’ and policy ‘drift’, rather than through formal legislative reform. It also takes up a number of other intriguing issues raised by recent trends: why, for example, market reforms are clustered in centralized political and medical frameworks; why these reforms have generally enhanced state authority rather than market autonomy; why, despite fragmentation, decentralized political and medical systems shifted towards an expanded government role; and why significant retrenchment of the public-private structure of health benefits occurred in the United States.

After the “Master Theory”: Downs, Schattschneider, and the Rebirth of Policy-Focused Analysis

Drawing on the pioneering work of Anthony Downs, political scientists have tended to characterize American politics as a game among undifferentiated competitors, played out largely through elections, with outcomes reflecting how formal rules translate election results into legislative votes. In this perspective, voters, campaigns, elections, and the ideological distribution of legislators merit extensive scrutiny. Other features of the political environment— most notably, the policies these legislators help create and the interest groups that struggle over these policies—are deemed largely peripheral. However, contemporary politics often looks very different than the world described by Downs. Instead, it more closely resembles the world described by E. E. Schattschneider—a world in which policy and organized groups loom large, the role of elections and voters is highly conditional, and the key struggle is not over gaining office but over reshaping governance in enduring ways. Over the last twenty years, a growing body of scholarship has emerged that advances this corrective vision—an approach we call “policy-focused political science.” In this framework, politics is centrally about the exercise of government authority for particular substantive purposes. Such exercises of authority create the “terrain” for political struggle, profoundly shaping both individual and group political behavior. Even more important, precisely because policies can have such substantial effects, they also serve as the “prize” for many of the most enduring players in the political arena, especially organized interest groups. The payoffs of a policy-focused perspective include a more accurate portrayal of the institutional environment of modern politics, an appreciation for the fundamental importance of organized groups, a better understanding of the dynamics of policy change, and a more accurate mapping of interests, strategies, and influence. These benefits are illustrated through a brief examination of two of the biggest changes in American politics over the last generation: partisan polarization and rising economic inequality.

The Policy Scientist of Democracy: The Discipline of Harold D. Lasswell

The “policy scientist of democracy” was a model for engaged scholarship invented and embodied by Harold D. Lasswell. This disciplinary persona emerged in Lasswells writings and wartime consultancies during the 1940s, well before he announced in his APSA presidential address, printed in the Review precisely 50 years ago, that political science was “the policy science par excellence.” The policy scientist of democracy knew all about the process of elite decision making, and he put his knowledge into practice by advising those in power, sharing in important decisions, and furthering the cause of dignity. Although Lasswell formulated this ambitious vision near the zenith of his influence, the discipline accorded the ideal—and Lasswell—a mixed reception. Some heralded the policy scientist of democracy; others observed a contradictory figure, at once positivist and value-laden, elitist and democratic, heroic and implausible. The conflicted response exemplifies Lasswells legacy. The policy scientist of democracy was—and is—too demanding and too contradictory a hero. But the vital questions Lasswell grappled with still must be asked a century into the disciplines development: what is the role of the political scientist in a democratic society? Do political scientists have any obligation to inform or shape policy? Are there democratic values that political science should serve, and if so, what are they? Lasswell never satisfactorily answered these questions. But in asking and trying to answer them—in his writings and in his own career—he was guided by a profound and inspiring conviction: Political science has a unique ability, and even perhaps a special obligation, to engage with issues of democratic choice that fundamentally affect the life circumstances of citizens.

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

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 peoples 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.

Drift and Conversion: Hidden Faces of Institutional Change

Until recently, institutionally minded scholars in the social sciences generally treated institutions as fixed. Whether defined as the rules of the political game, the standard operating procedures of bureaucracies, or the regularized norms guiding organizational behavior, institutions were associated with stability and were invoked as independent or intervening variables to explain persistent cross-national differences in outcomes. More recent work in the field, however, has attempted to provide greater insight into how institutions evolve and how institutional effects can change over time. Instead of seeing institutions as largely unchanging features of the political environment, these arguments seek to specify what kinds of institutional changes propelled by what kinds of social processes are most likely under what kinds of political configurations. This chapter advances this more recent agenda, examining two important, common, and theoretically explicable processes through which institutional effects change over time, which we call “drift” and “conversion.” Drift occurs when institutions or policies are deliberately held in place while their context shifts in ways that alter their effects. A simple example is the US minimum wage, which is not indexed to inflation and thus declines in value as prices rise unless new federal legislation is enacted. Those wishing to effect change through drift need only prevent the updating of existing rules. Drift thus depends on how sensitive the effects of an institution are to its context, whether policies are designed in ways that foster updating in the face of changing circumstances, and whether it is easy or difficult to block such updating. Conversion, by contrast, occurs when political actors are able to redirect institutions or policies toward purposes beyond their original intent. An example is the ability of corporations to use the Sherman Antitrust Act of 1890 to hinder labor unions. Passed amid widespread concern about corporate collusion, the legislation was meant to break up business trusts that were “in restraint of trade.” Yet corporations managed to convince federal courts that union organizing was “in restraint of trade.”