The Congressional debate over the health reform is starting to give me a headache. I worked in D.C. and know how these committees work. Tweak, tweak, back and forth, give here, take there. Forever.
The process can be dizzying – momentum, debate, stalemate, trillion dollars budgets, Ways and Means, Waxman, guidelines, computers, Dodd, HIT, lobbyists, activists, AARP, AMA, PHRMA, AHA, Kennedy or not, effectiveness, Baucus, socialized medicine, Snowe, Medicare, Medicaid, public plan. HELP.
But, I’m reading a book that offers some historical perspective on the process and asks the question – what does a president have to do to get a little health reform going?
The Heart of Power: Health and Politics in the Oval Office starts with FDR and looks at how each recent president approached health reform. Lyndon Johnson was “the most effective health care president in American history,” according to the authors, Brown historian James A. Morone and Obama advisor David Blumenthal. In studying how Johnson got Medicare passed and why the others made so little progress, they offer a list of lessons on how to get it done. Evidence-based health reform?
- The president needs to be committed to reform
- He or she has to act fast.
- The prez needs to be a cheerleader.
- He or she needs to know how to work Congress.
- The president needs to know when to push and when to compromise.
- He or she should give lawmakers the credit.
- Finally, the president has to ignore the economists. They call it a “heretical generalization…First expansion, then cost control.”
More detail in the pair’s piece in the NEJM.
In our view… contemporary analyses have focused too little attention on the most significant success in U.S. health care reform: the enactment of Medicare and Medicaid in 1965. This was the only time in our country’s history when the federal government extended health care coverage to a vast new swath of the American public. Recently released tapes of President Lyndon Johnson’s conversations in the Oval Office and other archival materials were not available to historians who wrote the definitive histories of Medicare’s passage. The new sources substantially change the story, alter some of the traditional conclusions, and introduce or sharpen striking lessons about how presidents should manage major health care reform.
As far as the book goes, I’m on Nixon and feel like I understand what is going on in D.C. much more clearly.