The Magazine

Healthy Obsession

Every modern president has his own cure.

Nov 23, 2009, Vol. 15, No. 10 • By TEVI TROY
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The Heart of Power

Health and Politics in the Oval Office

by David Blumenthal

and James Morone

California, 494 pp., $26.95

The Heart of Power begins with a story of how health policy expert and current Obama health IT czar David Blumenthal recruited the Brown political scientist James Morone to collaborate on a book on "how presidents deal with health care issues." By their own admission, they are writing the book with a political purpose--they express the hope that their book will "guide a new administration .  .  . toward winning social justice and the people's health"--but they have also produced a helpful history of both the health and health policies of almost all of the last 11 presidents, from FDR to Bush '43. "Almost all," that is, because they skip Gerald Ford, oddly whitewashing his health care policies and his presidency from their discussion.

Nevertheless, if you are interested in presidents and health care policy, this is the book for you. Of course, I'm not sure exactly how large that subpopulation is, but I'll leave that problem to the authors and to the University of California Press.

At its heart is an interesting idea, which is that presidents are most like real people in the realm of health care. Presidents don't go hungry or homeless, they don't schedule or drive themselves, but they do get sick and visit the doctor--er, have the doctor visit them. In addition, the Blumenthal/Morone analysis found presidents to be "distinctly unhealthy." Eleven of the 15 presidents who died in the 20th century died prematurely--"eight of them fell more than seven years short of the actuarial tables." We know a lot about the health of presidents, often more than we know about the health of friends or even some relatives: Ike's heart attacks, Kennedy's Addison's disease, Nixon's phlebitis. (Recall Jackie Mason's classic line on Nixon's painful and life-threatening swelling of the veins: "You don't screw 200 million people and get phlebitis. You get syphilis.")

Given their collective poor health, as well as the importance of the health issue to the American public, the authors describe how most of the presidents reviewed here made some kind of run at some kind of significant health care reform. One notable exception was George H.W. Bush, whom the authors claim could not be bothered with domestic trifles like health care while he had a world to fix. It was only in 1992, when worried about reelection, that Bush allowed his staff to come forward with a plan, and even then he had a hard time convincing voters he was serious about the issue.

According to Blumenthal/Morone, Bush would approach health care stakeholder meetings like a schoolboy trying to run out the clock in class to avoid a quiz. He would enter a room late, joke with the participants, talk about sports and world affairs, and only then, with a few minutes remaining, mumble something about his vision for health care reform. Even then, the authors claim (based on staff interviews) that Bush did not really understand, and could not fully articulate, that vision.

This is in stark contrast to George W. Bush, whom the authors credit mightily for his efforts in adding prescription drug coverage under Medicare. According to Blumenthal/Morone, on this issue President Bush was knowledgeable, skillful, and nimble throughout the deal-making process. In their words, "The details of an engaged, interested, and flexible President Bush surprised us." Another surprise for the authors was that, Lyndon Johnson aside, "Republicans have been far more successful at health reform than the Democrats." They do not, however, answer the obvious question their conclusion presents, which is why that is so. The furthest they go is to suggest that "Republicans get into [health reform] because of a president's personal bent, whether for systems reform (competition) or election-year insurance; Democrats go along for benefits they have invariably wanted for some time."

There is, of course, another possibility that the authors fail to suggest: Perhaps Republicans have tended to have more salable, or even better, ideas in this area.