Share this

When Bad Policy Makes Good Politics: Running the Numbers on Health Reform, Robert P. Saldin

Reviewed by Daniel Skinner



As Robert P. Saldin explains in his important new book, in 2009, the decades-long policy challenge of establishing a system for addressing Americans’ long-term care needs received a strong push that would eventually link its fate to the Barack Obama administration's signature legislative achievement, the Affordable Care Act (ACA). Almost as soon as it made it across the legislative finish line, however, the Community Living Assistance and Services and Supports (CLASS) Act was abandoned as unworkable. It was, as Saldin persuasively argues, both an unlikely victory and a predictable retreat.

CLASS's passage was unlikely in large part because of the history that preceded it. Given the many failed attempts at establishing a long-term care program—first as part of Medicare but also during the failed Bill Clinton–era health care reforms—long-term care was seen by most policymakers as prohibitively expensive and politically volatile. Among the vexing problems at long-term care's core were questions of means testing and universality, mandatory and nonmandatory enrollment and funding, and the relationship between services for seniors and those for the disabled. According to Saldin, the politics of long-term care converges—unproductively—with the politics of budgeting, and especially budgetary forecasting. This politics is

To continue reading, see options above.

More by This Author

Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle, Stuart Altman and David Shactman Reviewed by Daniel Skinner

About PSQ's Editor


Full Access

Join the Academy of Political Science and automatically receive Political Science Quarterly.


Policing: The Change America is Awaiting
July 23, 2020
7:30 p.m. – 9:30 p.m. EST


Editor’s spotlight

Race and Public Policy

Social Policy and the Welfare of Black Americans: From Rights to Resources
Charles V. Hamilton

Getting into the Black: Race, Wealth, and Public Policy
Dalton Conley


Search the Archives

Publishing since 1886, PSQ is the most widely read and accessible scholarly journal with distinguished contributors such as: Lisa Anderson, Robert A. Dahl, Samuel P. Huntington, Robert Jervis, Joseph S. Nye, Jr., Theda Skocpol, Woodrow Wilson

view additional issues

Most read

Articles | Book reviews

Understanding the Bush Doctrine
Robert Jervis

The Study of Administration
Woodrow Wilson

Notes on Roosevelt's "Quarantine" Speech
Dorothy Borg

view all

New APS Book

Presidential Selection and Democracy   PRESIDENTIAL SELECTION AND DEMOCRACY

About US

Academy of Political Science

The Academy of Political Science, promotes objective, scholarly analyses of political, social, and economic issues. Through its conferences and publications APS provides analysis and insight into both domestic and foreign policy issues.

Political Science Quarterly

With neither an ideological nor a partisan bias, PSQ looks at facts and analyzes data objectively to help readers understand what is really going on in national and world affairs.

Stay Connected

newsstand locator
About APS