The Biggest Government Health Care Spender Since LBJ Was…Ronald Reagan?

reaganMany readers will recognize Ronald Reagan’s famous maxim that: “Government is not the solution to our problem; government is the problem.”  Some will even recognize his vehement opposition to Lyndon Johnson’s Medicare proposal, before the program was passed into law:

“We are faced with the most evil enemy mankind has known in his long climb from the swamp to the stars.  There can be no security anywhere in the free world if there is no fiscal and economic stability within the United States.”

Reagan even warned at one point:

“If this program passes, behind it will come other federal programs that will invade every area of freedom as we have known it in this country until we wake to find that we have socialism… You and I are going to spend our sunset years telling our children and our children’s children what it was like in America when men were free.”

Pretty overwrought words, and clearly an inaccurate prediction.  But that’s not what I want to write about now.  Instead I want to talk about happened when Ronald Reagan was president, when he passed what David Blumenthal and James Morone describe as “the largest Medicare expansion in decades.”  What was this expansion, and how did Reagan come to embrace it? …(Read more and view comments at Forbes)

Name That President

mystery manRead the following quote, and try to guess which U.S. president made this statement:

“A responsible budget is not our only weapon to control inflation.  We must act now to protect all Americans from healthcare costs that are rising $1 million per hour, 24 hours a day, doubling every 5 years.  We must take control of the largest contributor to that inflation – skyrocketing hospital costs.”

Would you be surprised to learn that those words came out of the mouth of…Jimmy Carter?  It might be hard to remember, but Carter was essentially a fiscally conservative Democrat.  Probably more fiscally conservative than Ronald Reagan was during his presidency.  But in any case, Carter’s entire vision of healthcare reform was to control healthcare costs.  Not a vision easy to get many people excited about, as Paul Ryan has no doubtedly discovered more recently.  That might explain why Jimmy Carter got nowhere in reforming the U.S. healthcare system.
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Another Early Obamacare Supporter: Richard Nixon?!

nixonIn a previous post, I presented a quote from Dwight Eisenhower that foreshadows the Obamacare insurance exchanges, and argued that Obamacare is a centrist healthcare law, one that rather than socialize the healthcare system instead promotes private hospitals and private insurance companies.  I even wondered whether Eisenhower might support important components of the Affordable Care Act.
As it turns out, Eisenhower’s Vice President, Richard Nixon, also supported many reforms that later became parts of Obamacare.  While president, Richard Nixon put forward a Comprehensive Health Insurance Plan (or CHIP).  In CHIP, Nixon laid out a range of interventions, including… (Read more and view comments at Forbes)

Why JFK Failed to Pass Medicare

jfkIn a late night phone call during a foreign policy crisis, Kennedy expressed disdain for domestic policy, showing the kind of attitude that doomed later efforts to reform the U.S. healthcare system:

“It really is true that foreign affairs is the only important issue for a president to handle, isn’t it?  I mean, who gives a shit if the minimum wage is $1.15 or $1.25 in comparison to something like this?”

Need I say more?
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Medicare and the Desegregation of American Hospitals

segregated hospitalAs anyone who has followed the Obamacare roller coaster over the past 4 years knows, passing legislation is only the first step in reforming a healthcare system. Since Obamacare came into law, we have been consumed by battles over how to implement it, and by struggles over how to make it work effectively. But such implementation struggles are not new to Obamacare. We sometimes fail to remember that previous healthcare laws rolled out with a fair amount of controversy of their own.
For example, when Medicare was passed into law in 1965, the program was far from a done deal, especially in the South where Medicare threatened to end hospital segregation.
Federal programs had long been a challenge for those in the South who favored segregation. When Social Security was passed into law, southern Democrats managed to keep most black people out of Social Security by excluding farm and domestic workers from receiving such benefits. But Social Security eventually expanded to include these people, which did not please many southern conservatives. That’s why when Medicare was passed into law, they were determined to prevent it – another damn federal program – from interfering with the southern way of life… (Read and view comments at Forbes)

When It Came to Medicare Costs LBJ Concluded "What's $400 Million Between Friends!"

Lyndon_JohnsonLyndon Johnson’s advisers were worried. They were drafting a Medicare proposal, a major component of Johnson’s war on poverty. But the cost of this program was turning out to be much larger than expected. By their estimates, in the first year alone, they would face $400 million more in expenditures than they had budgeted for. The advisers asked Johnson what the administration should do, and Johnson replied: “Well, I guess I’ll run and get my brother.” That answer didn’t make sense to his aides, of course.  So he continued:

“Well, I remember one time they were giving a test to a fellow who was going to be a switch man on the railroad, giving him an intelligence test, and they said, ‘What would you do if a train was coming east going 60 mph, and you looked over your shoulder and another one was coming from the west going 60 mph?’  And the fellow said, ‘I’d go get my brother.’  And they said, ‘Why would you get your brother?’  And he said, ‘Because he hasn’t ever seen a train wreck.’”

Johnson was famous for using colorful yarns to calm his colleagues. When his colleagues pushed back on the cost of the impending legislation, he replied with another folksy story that put an end to any discussion of foregoing the legislation… (Read more and view comments at Forbes)

How Truman's Medicare Efforts Were Foiled by Red Baiting

trumanIn The Heart of Power, David Blumenthal and James Morone relate the 75 year history of presidential efforts (typically unsuccessful) to reform the U.S. healthcare system.  I used to think major reform efforts did not happen for many years after FDR’s New Deal.  After all, social security had taken a huge dent out of poverty among the elderly.  But healthcare costs were rising throughout the 1940s, and Harry Truman, FDR’s successor, was determined to provide all Americans with affordable healthcare.  In his 1948 State of the Union Address, Truman made his values clear.

“The greatest gap in our social security structure is the lack of adequate provision for the Nation’s health…this great Nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care.”

But with the communist Soviet Union on the rise, Truman’s ideas were susceptible to accusations of socialism.  Republicans and conservative Democrats used the Health Committee on Expenditures in the Executive Department to look for communists that might be influencing Truman’s healthcare reform efforts… (Read more and view comments at Forbes)

Abraham Lincoln Knew How to Milk a Metaphor

kid afraid of snakeI could go on quoting Abraham Lincoln all day long, for he was one of the finest writers of his or any time. Here’s one very special quote, where Lincoln uses the metaphor of a snake to make distinctions between slavery itself being bad, versus policies to limit slavery to the south, versus policies to prevent slavery from expanding into new US territories.

If I saw a venomous snake crawling in the road, any man would say I may seize the nearest stick and kill it. But if I found that snake in bed with my children that would be another question. I might hurt the children more than the snake, and it might bite them.

In other words, slavery is bad, but ending slavery in the South might harm unintended victims.

Much more, if I found it in bed with my neighbor’s children, and I had found myself by a solemn oath not to meddle with his children under any circumstances, it would become me to let that particular mode of getting rid of the gentleman alone.

In other words, once they signed on to the Constitution, Northerners became duty-bound to leave slavery alone in the south.

But if there was a bed newly made up, to which the children were to be taken, and it was proposed to take a batch of young snakes and put them there with them, I take it no man would say there was any question how I ought to decide.

And that is the reasoning by which Lincoln concluded that slavery should not be expanded into new territories, a position the south could not tolerate, because Southerners saw such a policy as the beginning of the end of slavery in their lands. What a brilliant way to frame the argument.
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Be Careful What Standards You Use to Judge Historical Figures: The Case of Abraham Lincoln

abraham_lincoln2It’s always tricky to judge anyone’s moral character, much less that of historical figures who lived during times very different from our own. Most of the great people who founded the United States, for example, had slaves. Some even sired children with those slaves – like Thomas Jefferson. Hard to know how to judge that.
But most people feel pretty comfortable judging Abraham Lincoln, as being a great man with views on race well beyond those of his times. And that, indeed, is the truth. But take a closer look at what enlightened thinking looks like in those times. Here are words from a speech Lincoln gave where he tried to draw on the distinction between freeing slaves versus giving Negroes complete equality:

I have never seen to my knowledge a man, woman or child who was in favor of producing a perfect equality, social and political, between Negroes and white men. I recollect of but one distinguished instance that I ever heard of, so frequently as to be entirely satisfied of its correctness – and that is the case of Judge Douglas’s old friend Col. Richard M Johnson.

This drew laughter from the audience, as Lincoln anticipated, because Johnson was known to have had children with a woman of “mixed race.” Lincoln then continued milking the crowd for laughter:

I will also add… That I have never had the least apprehension that I or my friends would marry Negroes if there was no law to keep them from it, [more laughter from crowd] but as Judge Douglas and his friends seem to be in great apprehension that they might, if there were no law to keep them from it, [even more laughter] I give him the most solemn pledge that I will to the very last stand by the law of this State, which forbids the marrying of white people with Negroes.

Remember that what Lincoln was espousing back then, as awful as it sounds to us now, was a dangerously progressive view at that time.
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How "Vague" Writing Can Be Powerful: A Lesson from Abe Lincoln

In his wonderful 1992 book – Lincoln at Gettysburg – Gary Wills explains that one of the reasons the Gettysburg address was so powerful is that Lincoln did not use any proper names – that’s right any – in the entire address. Consider this portion of the speech:

Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battlefield of that war. We have come to dedicate a portion of that field…

Not the Civil War but a civil war. Not the United States, but “that nation.” What’s the name of that battlefield? You won’t find that out by reading Lincoln’s speech. By being so nonspecific, so general, Lincoln made the message of his speech that much more universal. This is a writing lesson to keep in mind. Normally being more specific and more concrete makes writing more powerful. In this case, Lincoln found a better way to get his ideas across.
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