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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One intriguing but apparently unsalable idea died in the Reagan administration, when White House staffers put forward perhaps the most conservative approach to health reform of any of our modern presidents. Beryl Sprinkel, Reagan's chairman of the Council of Economic Advisers, developed (with assistance from the Heritage Foundation) a plan to "voucherize" public health care assistance. When Sprinkel presented the plan to the president at a cabinet meeting, he ran into staunch opposition from Doc Bowen, Reagan's secretary of health and human services. Bowen, knowing how Reagan liked stark images or graphics to make a point, took out a pen and drew a complicated chart showing the various and intersecting lines the plan would require. Although, by Bowen's own admission, he exaggerated the complexity for effect, he soon had the whole room laughing, and the administration quietly shelved the voucher plan. A decade later, conservatives would use a similar tactic to defeat Bill Clinton's proposed health care plan.

Blumenthal and Morone have loads of similar stories, both fascinating and little known. Franklin Roosevelt's adult-onset poliomyelitis was initially misdiagnosed twice by the physician who made a house call to the Roosevelt vacation home at Campobello. The erring doctor then had the nerve to charge the family $8,000 for the double misdiagnosis. Fans of P. J. O'Rourke will be happy to learn that Harry Truman was both the most "hale" president studied in this volume, and yet the biggest drinker of the bunch.
The hero, however, is Lyndon Johnson, who presided over the most eventful administration in history, from a health perspective. The authors show Johnson to have been a masterful behind-the-scenes presence during the creation of Medicare and Medicaid in 1965. Johnson worked secretly with the House Ways and Means Committee chairman, Wilbur Mills, on combining seemingly competing proposals to cover the elderly and the indigent into one giant, and still growing, system. It was a bold and risky move, but it worked--although the plan's passage was not always guaranteed. At one point, Johnson's chief health aide, Wilbur Cohen, warned LBJ about a new development that would increase the cost of the plan by $500 million in the first year.

Johnson's curious response: "Well, I guess I'll run and get my brother." He then proceeded to tell Cohen the story of a railroad switchman who was asked how to handle a pending and unstoppable train wreck: He said he'd get his sibling "because he hasn't ever seen a train wreck." Johnson was also quite good at convincing recalcitrant legislators to go along with him. Florida senator George Smathers told a reporter that he switched his vote on the Medicare bill from "against" to "for" because "Lyndon told me to."

While many of the stories told here are entertaining, and especially helpful during these health care-minded days for providing useful cocktail chatter, the stories do not necessarily create a narrative that explains the policies that presidents eventually pursued. If Truman
was healthier than FDR, why did he seem to try harder to create a universal health program? Could it be that other factors than presidential health determine the approach to health policy? If anything, the number-one factor determining the level of presidential attention to health care appears to be electoral politics. In the current situation, Barack Obama is "all in" on health care reform, and it is not at all clear that his status as an occasional smoker, or as someone who works out twice a day, has led him to place that bet.

Perhaps this relates to the fact that Blumenthal and Morone are interested in something more than a work of history. This becomes clear in their appendix, which is a list of keys for successful presidents in the area of health care. Examples of their suggestions include "Passion," "Speed," "Bring a plan with you," and, amusingly, "Hush the economists," which will likely be necessary in the current administration because of the stratospheric scores the various proposals have been generating from the Congressional Budget Office.

Given Blumenthal's closeness to many top Democratic health strategists--he has been a Democratic health policy adviser for over three decades--it seems probable that he has pushed this book's argument with the Obama White House. So the Obama team has been closely following many of his lessons, particularly the point about a need for "speed." At the same time, Republicans are hoping that they get to demonstrate the last lesson the authors suggest, which is "Learn how to lose."


Tevi Troy, the author of Intellectuals and the American Presidency, and a former White House aide and deputy secretary of health and human services, is a senior
fellow at the Hudson Institute.