Health Care Reform: What Would LBJ Do?
As the Democratic leadership keeps rolling over to one health care industry demand after another, I'm reminded of a post that I wrote on my Unsilent Generation blog nearly a year ago, as Obama prepared to take office after promising to reform the American health care system. It's about President Lyndon B. Johnson's successful effort, back in 1965, to create the Medicare and Medicaid programs–-the only single-payer health care this nation has ever known. Like a lot of LBJ's War on Poverty programs, they were far from perfect. But compared with what today's Democrats are offering, they were something close to radical, and represented a triumph of political will on Johnson's part.
I suspect that if if LBJ were alive today, he might have been able to get a decent reform bill through Congress, without all of the concessions to corporate interests that have rendered the Democrats' current legislation—including the public option—so weak that it is getting close to meaningless.
When it came to getting bills through Congress, LBJ—both as Senate Democratic leader and as president—had skills that make Nancy Pelosi, Harry Reid, and Rahm Emanuel, along with President Obama, look like rank amateurs. But more than this, he had the level of commitment—and the spine—required to stand up to opposing interests when it came to a basic need like health care.
I'm going to run most of that December 2008 post here, since its relevance has only increased with each passing month.
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An NPR story earlier this week included excerpts from Lyndon Johnson's White House tapes, featuring his behind-the-scenes efforts to pass the bill that created Medicare and Medicaid in 1965.
The idea of a Medicare-type program for seniors had been debated for more than 20 years, ever since Harry Truman's post-World War II calls for a national health care system. But it was Johnson, famous for his arm-twising skills, who finally succeeded in sheparding the legislation through Congress. He did so against the wishes of the American Medical Association and much to the chagrin of conservatives, who saw it as a step down the slippery slope toward socialized medicine.
The Oval Office tapes feature Johnson's typically colorful language. As NPR describes it, "Just moments after [the] bill…got through a key House committee in March of 1965, Johnson sounds like he's in no mood to celebrate. He gets on the phone to demand that legislators keep the bill moving":
"You just tell them not to let it lay around. Do that," Johnson barks. "They want to, but they might not," he continues. "Then that gets the doctors organized, then they get the others organized. And that damn near killed my education bill. Letting it lay around. It stinks. It's just like a dead cat on the door. When a committee reports it you'd better either bury that cat or get some life in it."
The NPR story is based on an article in the New England Journal of Medicine by David Blumenthal, who teaches at Massachusetts General Hospital and Harvard Medical School and served as an Obama campaign adviser on health care. Blumenthal thinks Johnson's strategy could be instructive to the new president as he seeks to pass health care reform.
But what Johnson had going for him was not only his skill in dealing with Congress, but his commitment to expanding Americans' access to health care, regardless of the cost. In March 1965, he told Vice President Hubert Humphrey:
"I'll go a 100 million or billion on health or education. I don't argue about that any more than I argue about Lady Bird buying flour. You got to have flour and coffee in your house. And education and health, I'll spend the goddamn money."
Comments
Please, not another facile
Please, not another facile explanation of how someone else could supposedly have done so much better. Legislation is a product of a point in time, and the time is much different. Context is important.
LBJ and many of his Republican opposition were good friends and cooperative on many issues. There was no Rush, Fox, and the right wing (Goldwater) had been beaten back - and, at the time, the Republicans had some principles.
He had different levers of power that are not really available today to BHO. Among other things, the economy was good. People broadly supported public action (this was before Ronald Reagan and "government is the problem."
If LBJ were such a genius, he would have figured out the problem with guns and butter (leading to rampant inflation) and how to manage a brutally unpopular war.
Republicans Use Healthcare to score a coup!
GET THE FACTS BEHIND THE NEWS!
The Republican party has an opportunity to seize this moment and establish themselves as the leading party. As the discussions on healthcare reform continue it has become apparent that the public wants healthcare reform that will cover almost everyone and they want it at the lowest cost possible.
Republicans have come up with several good ideas, selling insurance across state lines, giving individuals the same tax breaks as those who get insurance thru their employers, tort reform to lessen Doctors insurance costs etc. These idea will help but are not sufficient for almost universal coverage at the lowest cost possible.
How to save BIG MONEY on healthcare REFORM!
Despite all the smoke and mirrors the best opinion shows that the public option saves money not costs money. The Urban Institute of Washington DC estimated that a gov’t insurance plan would save $224 to $400 billion over a period of 10 years. The private insurance co’s simply will not offer the low cost full coverage insurance plans that would reduce the subsidy for the uninsured and underinsured. The gov’t plan would. The Massachusetts experience using Heritage Foundation ideas with exchanges has covered over 97% of the people but at high cost. Yearly insurance plans run from $800 to $1,000 per month. The Congressional Budget Office has confirmed the money saving of public option plans by estimating that the cost of one of the proposed House plans would be reduced from $1.1 billion to only $800 billion, a saving of $300 billion over a 10 yr period with a gov’t plan. The polls show 60% of the public want a gov’t option.
There is another important step we can take to reduce cost by an estimated $40 billion annually or $400 billion over a 10 year period.
According to Drs. David Himmelstein and Steffie Woolhandler Physicians for a National Health Plan the public option misses at least 84 percent of the administrative savings available through a single payer, gov’t, healthcare plan. The public plan option would not do anything to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes. They would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. The Physician group research in California showed that now 31% of every health care $ was paid for administrative costs. This compared to 3% of Medicare administrative costs. The PNHP single payer information is available at Tel 312-782-6006, info@pnhp.org.
The Republicans will introduce a single payer healthcare reform bill with a gov’t plan. Many liberal democrats will go along .The Republicans wiil take control of the healthcare reform debate and give the public what it wants.
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If you can not sell on the
If you can not sell on the substance, sell on personal charm. I did not think Chicago mob ever needed charm. They rather use batons, kick legs, twist arms and break knee caps. Obama has to really CHANGE!
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