Chronic Politics: Health Care Security from FDR to George W. Bush.

by Craig Ramsay

Chronic Politics: Health Care Security from FDR to George W. Bush. By Philip J. Funigiello. (Lawrence, Kans.: University Press of Kansas, 2005. Pp. x, 395. $39.95.)

Implacable opposition from effective interest groups, a government system with separation of powers, a fragmented Congressional legislative process, undisciplined political parties, and a political culture rooted in individualistic, antigovernment attitudes are the familiar factors at the heart of this author's retelling of one of the most prominent U.S. public policy-making sagas. Phillip J. Funigiello clearly regrets the failure to achieve universal, comprehensive health care coverage because of its important role in his conception of social justice. He occasionally lets out a polemical point but by and large avoids moralizing in favor of a well-crafted, detailed chronological account. At the end of each chapter, he includes an interpretive summary of that chapter, including tying in the past and future. The pre-New Deal phase of the story beginning in the Progressive Era [1890-1920] in the states is only briefly touched on in favor of focusing on the evolution of the federal government's role from the 1930s through the Bush administration's Medicare prescription drug legislation.

This policy area is complex and important enough to warrant an updated book-length history now and then. Funigiello's willingness to look afresh at the primary and secondary sources and his ability to write in a clear, compelling fashion about fascinating personalities and events distinguish his descriptive analysis. Sixty-four pages of notes and a thirteen-page bibliographic essay are a testament to his research efforts and provide an excellent background for the reader.

The foundational role of the National Health Inventory conducted by the Roosevelt administration; the intricacies in the political maneuvering by Wilbur Mills, Chairman of the House Ways and Means Committee in the run up to Medicare; and the pivotal role of the presidential task force headed by Hillary Clinton are highlighted through detailed evidence derived from Funigiello's archival work. As with his analytical approach throughout the book, he emphasizes in these three instances the importance of the strategic and tactical choices made by the policy actors. He does not see or seek deterministic explanations. He sheds light on the series of contingencies that repeatedly reconfigure themselves across over one hundred years of policy-making episodes.

In discussing the most recent failed attempt at comprehensive reform in the Clinton administration, Funigiello rightly points to the role of the media in framing the issues and the ambivalence of the middle class as obstacles that go beyond the long-standing political and structural factors. Although these are factors worthy of serious consideration, he underdevelops this section by not drawing more on such analysts as Marmor, Skocpol, and Jacobs. Such points as "middle-class voters were not overly troubled by the plight of the working poor and the uninsured" would have benefited from additional discussion as offshoots or new factors (303).

The combination of a solid grounding in scholarly research and a compelling writing style make Funigiello's book accessible and rewarding for academics, students, and interested members of the public.

Craig Ramsay

Ohio Wesleyan University