PROVIDENCE, R.I. [Brown University] — As President-elect Barack Obama prepares to make health care reform one of his administration’s top priorities, Brown University political scientist James Morone urges him to study Lyndon Johnson’s historic enactment of Medicare and Medicaid in 1965 — the only major expansion of health insurance coverage in U.S. history. In an article published in this week’s New England Journal of Medicine (NEMJ), Morone and David Blumenthal of Harvard University provide six historic lessons for the future president to consider.
The analysis is based on recently released tapes of Johnson’s Oval Office conversations and other archival sources that were not available to previous historians. The article describes the behind-the-scenes role Johnson played beginning at the start of his presidency and how he strategically wooed the legendary Ways and Means Chairman Wilbur Mills to ensure action.
Some of the lessons highlighted in the NEJM article:
- A President must be deeply and personally committed to improving health care. Though Johnson was swept into office with an historic landslide, he had “to press relentlessly” to pass Medicare and Medicaid.
- Johnson saw his mandate as “fragile and fleeting,” and was obsessed with speed. The authors warn Obama to avoid waiting too long to introduce health reform bills or he risks emboldening the opposition.
- Johnson understood the legislative process and hired a “crackerjack” legislative team.
- Johnson delegated details and relinquished credit. He chose principles to insist on and let his aides and Congress manage the specifics.
- Johnson “quieted his inner economist” and did not fixate on how much the new programs would cost. Although this will be much harder for Obama given the realities he’s working under, Blumenthal and Morone say he will have to find a way to be successful since “accurate cost estimates might have sunk Medicare.”
“Policy-makers focus a lot on other health reform missteps but little attention is paid to the successful lessons of Lyndon Johnson and Medicare,” says Blumenthal, a national health policy expert and director of the Institute for Health Policy at Massachusetts General Hospital, who advised the Obama campaign.
“For Obama, speed is of the essence,” says Morone, chair of the Department of Political Science at Brown and the author of Hellfire Nation: The Politics of Sin in American History. “He has to make health care reform a priority and move fast. A president loses a little power every day that he’s in office — he doesn’t stockpile it. Johnson and Roosevelt are great examples of that.”
The NEJM article is an excerpt from a forthcoming book Blumenthal and Morone have written about health and politics in the Oval Office. The Heart of Power: Health and Politics in the Oval Office will be published in April 2009 by California Press.