When it comes to major social policy issues like welfare, civil rights and reproductive health, presidents have not been able to draw on personal experience to inform their views or stoke their passions.
They haven’t lived on the streets or faced long-term unemployment; they haven’t been pregnant or raised children on their own; and, with one exception, they haven’t confronted barriers of race, gender or sexual orientation.
Health care, however, is a major exception to the rule.
All presidents have had to manage their own health, and most faced serious—even life-threatening—health problems before or during their presidencies. Franklin Roosevelt, for example, battled polio; Dwight Eisenhower suffered heart attacks and strokes; John F. Kennedy received his last rites four times as an adult; Lyndon Johnson nearly died from a major heart attack; and Richard Nixon suffered from alcoholism and mental illness.
How have the health-related experiences of these and other modern presidents affected their views and actions on the effectiveness, quality and cost of our nation’s health care system? And what can President Obama and his successors learn from their predecessors as they seek reform?
These are the questions posed by David Blumenthal, M.D., M.P.P., a Robert Wood Johnson Foundation (RWJF) Investigator Awards alumnus and a former member of its National Advisory Committee who is now National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, and James Morone, Ph.D., a chair and professor of political science at Brown University, a two time Robert Wood Johnson Investigator Award winner and a current member of the National Advisory Committee of the RWJF Scholars Program, in their newly released book, Heart of Power: Health and Politics in the Oval Office.
Part biography, part history, and part policy guide, Heart of Power analyzes presidents from Franklin Delano Roosevelt to George W. Bush. The lessons these men learned about health care policy are especially illuminating as the nation debates the most extensive overhaul of its health care system in half a century.
Passion for Reform a Key Ingredient for Success
Presidents’ own experiences with health care, it turns out, shed little light on their health care views, Blumenthal and Morone argue. Presidents have, for the most part, tended to keep their personal health problems private, leaving little in the public record about how those experiences shaped their views on health policy.
But as presidents watched a loved one battle disease and death, most developed a passion for the issue that drove their mission to change the nation’s health care laws.
It is that passion for health care that has, in fact, been the key ingredient in any presidential effort to overhaul health care policy in the last century, the authors argue.
It was passion that led budget hawk Dwight Eisenhower, who watched his mother-in-law die in the White House, to hike funding for health care. It was passion that led Kennedy, whose father suffered a stroke during his presidency, to take on the unpopular campaign for government-sponsored health care coverage for the elderly. And it was passion that led Nixon, a conservative whose two brothers died of tuberculosis as children, to side with liberals on the question of universal coverage.
Obama—who lost his mother and grandmother to cancer—has deep passion for health care reform, Morone says. It is this fire in his belly, Morone speculates, that has kept Obama from giving up his mission to overhaul the nation’s health care system even as the economy went into a tailspin.
But passion isn’t the only key to success, Blumenthal and Morone argue. Presidents must also learn to ignore economists who say the price tag for reform is too high; move quickly to enact reform; work closely with Congress to keep the legislative process moving; build a grassroots movement to pressure lawmakers to act on reform; focus on big ideas rather than policy minutiae; and if failure occurs, don’t walk away from the issue and let the critics control messages in the media.
So how is Obama doing? He has, for the most part, followed the guide laid out in Heart of Power, Morone says, and although victory is not assured, it is within reach. “Barack Obama is going to come as close as anyone has ever come to national health insurance. But whether he makes it across the finish line is unclear.”