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The Author Speaks

In Sickness and in Health

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

Q. Why was that a problem?

A. The Republicans were terrified of health care passing under Clinton. If it did, the Democrats would renegotiate their lost link to the middle class and the GOP would be out of power for a long time. But once Clinton walked away, the GOP controlled the spin, giving their party credit for saving America. Clinton did the exact opposite of Harry Truman. Truman lost his health care insurance fight but continued to campaign for his cause. “The do-nothing Congress, the American people need this!” he’d say.

Q. So Clinton walked away …

A.and health insurance drops out of the debate for a decade. And not coincidently, we believe, so did the Democratic majorities.

Q. George W. Bush had a different approach.

A. We came away pretty impressed with G.W. Bush on this issue. G.W. wanted to turn Medicare into a market-driven program and use prescription drugs to do it. His idea: You can have prescription drug coverage as long as you agree to let private insurance companies handle all your Medicare. Once he got a majority in Congress after the 2002 midterms, he turns to health care.

Q. And how’d he do?

A. He read the briefing book. He listened, asked intelligent questions. He kept the big picture in mind and sent a series of principles, not a detailed plan, to Congress. He was flexible, backing off on many of the components of his initial idea. He ran a very disciplined campaign to get the prescriptions drugs benefits through, which was considered a victory for him.

It’s a delicious irony of history. Look at the two greatest expansions of Medicare. The first comes under Reagan, the most conservative president of our story, and the next comes under G.W. Bush, the second most conservative.

Q. How’s Obama’s health care campaign going?

A. He’s doing remarkably well. FDR, Truman, Kennedy, Clinton, Carter—all tried major health reform and all failed somewhere in the process. Not one of them even got it through a single House committee. [Lyndon] Johnson is the great Democratic exception, getting Medicare passed. Obama has gotten four out of five congressional committees and he seems to have a plan before the House. He’s learned the lesson of speed. He’s managed Congress reasonably well. And he understands he has to sell it and use his credibility with the public.

Q. He also seems to have the passion. In a radio town hall at AARP, the president mentioned that while his mother was battling cancer, she was also battling her insurance company—and she’d already paid her premiums. He was a little riled up when he said this, whereas the rest of his comments were much more measured.

A. This is what we look for in presidential biographies. Every now and then you see what makes them tick. What you saw in that meeting was exactly what we’ve seen from other presidents—there’s Barack’s heart under that measured exterior—the reason he goes messing around in the weeds of health care reform.

Q. Will his efforts be rewarded?

A. All you have to do is watch the conversation. If the public seems to be terrified of reform, it will fail. This is now in the hands of the public … the public of those swing states, who are now really going to let their congressmen hear it during the recess. There are no holds barred in this debate. You are not limited to the truth. There’s going to lying, cheating and stealing. And like always in great democratic debates, when Congress comes back in session we’ll know.

Q. Handicap Obama’s chances.

A. He’ll actually succeed. It will be a heavily compromised plan. But if I had to make a bet, I would give it 51-49 percent that this time they’ll actually do it.

Carol Kaufmann is a contributing editor at the AARP Bulletin.


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