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In Sickness and in Health

In this interview, James A. Morone speaks about how presidents' personal experiences shaped their health care policy.

Q. That must have had a huge impact on him.

A: His illnesses never touched him in terms of advocating national health insurance. But when his father had a stroke in 1961, he was devastated. From that moment on, he was definitely committed to Medicare. He’d say, “I just don’t know how regular people do it.” His father was rich and it was costing the family a fortune.

Q. Talk about the health of JFK and Richard Nixon during their famous televised presidential debate.

A. So JFK was this incredibly sickly guy. He was pumped up with drugs directly into his back up to five times a day. So the ruddy good health that he displayed was really chemical. Despite his incredible sickness, he was manic about seeming young and strong. Richard Nixon had terrible psychological problems, but physically he was a very strong and healthy guy. But on the campaign, he had gotten a knee infection. And on the day of the debate, he banged his knee on the door of the car and it caused him great pain. So on TV we had an essentially healthy man sweating profusely due to pain, appearing quite ill at ease. And the other man looked robust and healthy, who was actually very sick.

Q. Why did Nixon care so much about health care?

A. This was one of the shocks. We discovered a man deeply affected by the death of his two brothers. Every moment of great tension in Nixon’s life, he immediately started talking about his mother who left him in the hands of his incredibly abusive father and took one of his brothers, who had contracted tuberculosis, to Arizona. She then took in boarders—other boys with TB—and watched them die one by one as she tried desperately to keep Richard’s brother alive. It didn’t work. He died. And another brother also died of TB. So that’s the backstory. (Read more of Nixon’s story.)

Q. And we rarely hear of Nixon’s health care legacy.

A. He recast the entire concept of national health insurance, creating a new model that kept employer health care in place, covered the poor and the old and gave people who weren’t covered national health insurance. Before that, most people who wanted national health insurance wanted a single-payer Medicare system for all. But this mixed model has been embraced by Carter, Clinton, Obama and all the Democratic hopefuls who ran on health care—Kerry, Dukakis, Mondale. They’ve all borrowed from Nixon,who wrote up this idea on his yellow legal pads.

Q. Yellow legal pads?

A. He would hide in his secret office across the street from the White House in the middle of the summer with the air conditioner going full blast and a fire in the fireplace and fill yellow pads with ideas. Here he brilliantly rethought national health insurance. He conceived the plan of the future, the one we’re still pursuing. He came close to concluding a deal with the Democrats, but the Republicans balked and ultimately, Watergate consumed the presidency.

Q. Another Republican who wanted to expand government health care coverage was Ronald Reagan.

A. This was another shock. Reagan has an image of being totally out of it. At the low point of his presidency—the Iran-Contra scandal, the Republicans just lost the midterm elections and Reagan had suffered a serious cancer episode—he decided to go forward with catastrophic coverage for Medicare recipients. Ronald Reagan, Mr. Government-is-not-the-Solution, added the single largest expansion of Medicare of all time. [Ultimately, the initiative didn’t survive Congress.]

Q. Bill Clinton certainly had the fire in the belly for health reform, yet ultimately nothing happened.

A. Clinton is all lessons about how not to go about health care reform. One, he waited. The plan didn’t go to Congress until the last day of the session when Congress was leaving. By then, everyone was focused on the midterms. Huge problem. Second, he spent way too much time on the details, not the big picture. But the big lesson here is learning how to lose. When national health insurance went down to defeat, Clinton simply walked away.

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