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."