POSC 459 — Social Welfare Politics and Policy · Week 10, Monday 26 October 2026
Accessible text version of the Week 10 Monday slides — same content in linear order, with no slide-scaling container. Readings: Jacobs and Skocpol, Health Care Reform and American Politics, ch. 1; Hacker (2010), “The Road to Somewhere,” Perspectives on Politics 8(3).
POSC 459 — Social Welfare Politics and Policy Week 10 · Monday, October 26
Jacobs and Skocpol, ch. 1 · Hacker (2010), “The Road to Somewhere”
| Part | Points | Command | Working | Coverage |
|---|---|---|---|---|
| I. Five IDs | 25 | 5 each: meaning, source, what it explains | ||
| II. Essay | 50 | 46–50 | 40–45 | 34–39 |
| III. Program | 25 | 23–25 | 20–22 | 17–19 |
Comments are on the cover and in the margins. Scores are in Canvas.
Questions about a score: office hours or email this week, book in hand
| Mon 10/26 | Jacobs and Skocpol ch. 1 · Hacker (2010) |
| Wed 10/28 | Jacobs and Skocpol ch. 2–3: the year of pitched battles |
| Wed 10/28 | Policy brief due 11:59 p.m., Canvas |
| After you submit | Term Paper Dialectical Partner unlocks in PapyrusAI |
Why did it take a century?
Why 2010?
Why so much less than reformers wanted?
Why so angry?
“So You Think You’re Insured? (Think Again)” Time, March 16, 2009
Pat Tumulty, San Antonio. Six years without job-based coverage. Six-month Assurant policies, high deductible. Kidney failure. “Preexisting condition.” Claim denied. Hospital’s highest rates. Texas Medicaid: adults with children, 26% of poverty.
Jacobs and Skocpol, pp. 1–2
38 million working-age Americans and family members Three-quarters work. More than half full-time.
| Wage fifth | Uninsured, ~1980 | Uninsured, late 2000s |
|---|---|---|
| Top two-fifths | still over 90% covered | |
| Middle | 5% | 12.4% |
| Fourth | under 10% | 21.9% |
| Bottom | 18% | 37.4% |
Jacobs and Skocpol, p. 3; plus 16 million underinsured
| Country | Health spending, % GDP, 2006 |
|---|---|
| United States | 15.3 |
| Switzerland | 11.3 |
| France | 11.0 |
| Germany | 10.6 |
| Canada | 10.0 |
| Britain | 8.4 |
US: 7.2% of GDP in 1970 → 15.3% in 2006 → 17.6% projected 2009 Infant mortality: 28th in the world
Jacobs and Skocpol, pp. 3–4, OECD
Jacobs and Skocpol, pp. 5–8
Jacobs and Skocpol, pp. 10–14
| Popular vote | 53–46 |
| Electoral College | 365–173 |
| “Most important issue”: the economy | 63% |
| “Most important issue”: health care | 9% |
| Worried about affording health care | 66% |
Jacobs and Skocpol, pp. 14–16, exit polls
Delay: Biden, Axelrod, Emanuel, Geithner. “I don’t want to fail.” Go: Kennedy, Baucus, the party base. Orszag: no deficit control without health reform.
Obama: “victories would beget victories”
Jacobs and Skocpol, pp. 16–20
Why did it pass?
Why so limited?
Why so
polarized?
Hacker (2010), p. 862
Democratic president + Democratic Congress, 2006 and 2008
Fewer Jim Coopers: a more homogeneous caucus
Necessary. Not sufficient.
“Why this approach? Why this session? Why did Obama push forward given how much else was on his plate?”
Hacker, pp. 863–864
| Factor | 1993–94 | 2009–10 |
|---|---|---|
| Economic context | Short 1991 recession | Deep downturn; 2-to-1 said “take it on right now” |
| Group conflict | Harry and Louise 1.0: “There has to be a better way” | Harry and Louise 2.0: “It’s about time” |
| Democratic coalescence | Single payer vs. play-or-pay vs. incrementalism | One plan, the Massachusetts template |
Hacker, pp. 864–867
The quid pro quo: more public regulation and financing in return for guaranteed customers
Hacker, pp. 864–865
Hacker, pp. 866–867
“It incorporates all sorts of Republican ideas.” — Barack Obama, Today, March 2010
Roots: the employer-based path, and Medicare 1965, which covered the sympathetic and left the rest
Hacker, p. 867
| Cloture motions filed since 1919 | 1,200+ |
| Filed since 1981 | over 80% |
| Filed since 1993 | over 60% |
| Bob Dole, 1994 | “You need 60 votes to do anything around here” |
| The Gang of Six | 6 senators, 2.7% of Americans |
| Max Baucus, health-industry money, 2007–08 | $1.5 million |
Hacker, pp. 867–868
| Provision | House bill | Senate bill | Final law |
|---|---|---|---|
| Public option | ✔ | ✘ | ✘ |
| National exchange | ✔ | state exchanges | state exchanges |
| Tough employer requirement | ✔ | weak | weak |
“What stood in the way of the public option… was less Joe Lieberman than a once-obscure procedural rule.”
Hacker, pp. 868–869
Three fights the White House picked, against public opinion:
Reason: the CBO score. The mandate kept the exchanges from becoming a dumping ground; the plan tax scored as savings.
The public option would have saved ~$150 billion over ten years. It faced the fiercest group resistance, so it went.
Hacker, pp. 869–870
“American politics has often been an arena for angry minds.” — Hofstadter, 1964
Hacker, pp. 870–872
Harkin: a “starter home”
Social Security’s “cruel hoax” to “third rail” took decades, in a friendlier fiscal climate, with a simpler program
No tangible benefits for years. A complex statute to implement and defend.
“Policy substance matters.”
Hacker, p. 872; Lasswell: who gets what, when, how
| Problem | What would fix it? |
|---|---|
| No job-based coverage, six years | |
| Policy cancelled after diagnosis | |
| Hospital list prices, no bargaining pool | |
| Texas Medicaid: adults with children only, 26% of poverty |
3 minutes with a neighbor. Name the provision, from ch. 1–4 or anything you know
Jacobs and Skocpol, ch. 2–3
Who fought for what, why, and how Summer 2009, the town halls, Scott Brown, and the final votes
Read for: which of Hacker’s three factors shows up in the fight, and which one almost failed
Questions: office hours Tuesday, or email the draft
It passed because the groups split, the party agreed, and the window opened.
It was limited by the path, the Senate, and the score.
It was angry because of a party, not the public.
Wednesday: ch. 2–3, and the brief at 11:59