The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States

by Jacob S. Hacker

The Divided Welfare State is the first comprehensive political analysis of America's distinctive system of public and private social benefits. Everyone knows that the American welfare state is unusual--less expensive and extensive, later to develop and slower to grow, than comparable programs abroad. Yet, U.S. social policy does not stand out solely for its limits. American social spending is actually as high as spending is in many European nations. What is truly distinctive is that so many social welfare duties are handled not by the state, but by the private sector with government support. With sweeping historical reach and a wealth of statistical and cross-national evidence, The Divided Welfare State demonstrates that private social benefits have not merely been shaped by public policy, but have deeply influenced the politics of public social programs--to produce a social policy framework whose political and social effects are strikingly different than often assumed. At a time of fierce new debates about social policy, this book is essential to understanding the roots of America's distinctive model and its future possibilities. Jacob S. Hacker is the Peter Strauss Family Assistant Profesor of Political Science at Yale University. Previously, he was a Junior Fellow of the Harvard Society of Fellows and Fellow at the New America Foundation as well as a Guest Scholar and Research Fellow at the Brookings Institution. He is the author of The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security (Princeton, 1997), which was co-winner of the 1997 Louis Brownlow Book Award of the National Academy of Public Administration. His articles and opinion pieces have appeared in The New Republic, The Nation, the Los Angeles Times, Boston Globe, and Washington Post. A regular media commentator, he has discussed his work widely on C-Span, national public radio and in papers nationwide.

Genres: Politics, Health Care, Government, Nonfiction, Economics

447 pages, Paperback

First published September 9, 2002

Reviews

[Lobstergirl · Rating 4 out of 5]

A deeply depressing account, from a political science perspective, of how public and private pensions and healthcare developed along parallel but very different tracks in the 20th century. The passage of Social Security in the 1930s meant that private employer-provided pension plans arose in response to it and in accommodation of it, while the failure to establish any kind of serious national healthcare system allowed for private, employer-provided health insurance to develop first, and mitigate the perceived need for, and complicate the political struggles for, any kind of public health benefits. The "path dependence" of established systems meant that Medicare could be passed because it applied to a limited group of those not already covered by employer-based insurance, and thus did not threaten private health insurance, but universal health insurance would always encounter severe resistance from entrenched interests. Hacker cites a litany of reasons why America has never been able to establish universal national healthcare: political opposition in Congress; the resistance of doctors and the AMA, business, and often organized labor; America's fragmented political system; and a myriad of incremental adaptations to the private benefits system that always made sweeping reform more difficult and less appealing. Hacker relies heavily on the idea of path dependence to explain how and why pensions and health insurance developed in the divided way they did: "choices at one point in time reduce the feasibility of other, once-conceivable, options by putting in place enduring institutions or by setting in motion self-reinforcing processes that are difficult to undo."

[Ben · Rating 4 out of 5]

Attempts to explain the relative success of old age pension (through the year 2000 or so) and the failure of public health in the United States. Does this with a heavy emphasis on path dependence and inertia. Private benefits fragment the public, and disproportionately help the organized, the healthy/ low risk, and the wealthy. As they become entrenched, it becomes more difficult for the government to provide health benefits, and when they do, it they necessarily do so only for the highest risk, highest cost portion of the population. Post-war as labor began to collectively bargain for health care, they traded long term possibilities for short term necessities - further entrenching the role of the employer as provider of health benefits. Helps to explain the unique public-private welfare state in the US. Well argued, but painful to read, and incredibly repetitive, this could pretty easily have been a 30 page article.

[Paul · Rating 2 out of 5]

A good graduate thesis in political science, but not a great book. There is a great deal of interesting history and background information on pensions and health care financing, which is useful to re-summarize. However, Hacker's writing is so often unclear and not always analytically sharp that it makes for tough going. There are many instances when his theory of why employers provide one type of benefits (say pensions) clashes with his theory of why they provide another type (say health care). This will be utterly frustrating for economists.

[Erica · Rating 3 out of 5]

This was a very detailed account of the public and private pension and health care systems (pre- Obamacare)in the US. It contained quite a bit more detail than I necessarily cared to read, but the overall theme of path dependency was fascinating. I certainly recommend this book to anyone who has an interest in social security, retirement, and health care policy (none of which happen to be specialty - the reason it is only 3 stars).

[Read a Book · Rating 2 out of 5]

A solid history of America's efforts towards health reform, but very dense for a casual reader. Those professionally interested in the field will enjoy.