The Heart of Power: Conclusions

The Heart of Power: Health and Politics in the Oval Office, David Blumenthal and James A. Morone. University of California Press (420pp).




I've read many books that expanded my store of knowledge, but few that changed my perspective. The Heart of Power changed the way I view health care policy and the ongoing debate about it.

Although the book covers the policies of each presidential administration from Franklin Roosevelt to George W. Bush (Gerald Ford excepted), it lays a foundation for an historical understanding of why Barack Obama made the critical decision to endorse a plan based on a public-private partnership. Blumenthal and Morone show convincingly that while liberals promoted and sustained the idea of universal health care access, conservatives were, over time, able to define the terms of the debate.

Obama took office with a commitment to health care reform, and immediately disappointed many of his supporters (including me) by not pursuing a single-payer plan. But Blumenthal and Morone demonstrate that progressives were never able to develop a constituency for single-payer outside of themselves. Pursuit of single-payer in 2010 meant overcoming a number of obstacles:

• redefining a debate that had been in place since the early 70s;
• attacking the insurance industry head-on;
• persuading the moderate Democrats to support single-payer.

As brilliant a politician as Lyndon Johnson barely succeeded in passing Medicare during one of liberalism's peak years; a major offensive for single-payer in this day and age was simply not going to succeed, and the price of failure would have set the possibility for any health care reform back for a generation. Like it or not, Obama acted pragmatically in pursuing and passing the new law.

In their summary, Blumenthal and Morone outline eight principles of success for any president striving for health care legislation (Jeff Goldsmith of Health Affairs Blog evaluates Obama on each principle here; I've included his letter grade below):

1. Passion. A president must care about health reform deeply enough to be willing to risk his presidency on it. (A+)
2. Speed. The longer a president waits, the more his popularity erodes and the more difficult the task becomes. The more drawn out the process becomes, the more difficult passing legislation becomes. (C+)
3. Bring a plan with you. Work on health care reform ideally begins with the transition to office or even before. (B-)
4. Hush the economists. It's counterintuitive, but critical. More than one administration economist has strangled health care reform in the cradle. (A)
5. Go public. Only the president can sell his plan to the electorate and to politicians. Visibility is critical. (B+)
6. Manage Congress. Despite diametrically opposed styles, Lyndon Johnson and Ronald Reagan excelled at this. Lesser presidents must understand the system and install an effective staff with experience at working with Congress. (A-)
7. Forget the PSROs. Jimmy Carters and Bill Clinton ran aground by immersing themselves in policy detail instead of tending politics. The president's job is to sell the plan and focus on the votes. (A)
8. Learn how to lose. If you lose, try to leave something in place for your successor. Roosevelt cultivated the idea; Nixon left subsequent Republican presidents with a framework. (F, although NA seems more appropriate to me.)

I have two criticisms of The Heart of Power. First, the copy editing is execrable -- I'd estimate an error in punctuation, spelling, or conjugation every 10-15 pages. For example, President Obama's name is "Barack," not "Barak," and Bob Dole is from "KS," not "KA."

Second, The Heart of Power would have been even stronger had it consistently considered the state of American health care in the context of each presidency. Sometimes, it's a little difficult to figure out exactly what problem a president is attempting to address and why. For example, was Bush I's disinterest in health policy a matter of inclination or philosophy, or did he believe that there was no problem? How and when did the health insurance industry become so powerful? Why and when did the medical establishment become divided over health care reform?

Overall, though, this is one of the few books that, without reading it, the individual citizen has an incomplete picture of an issue. We need more books that, like The Heart of Power, cover the history of a policy from its inception through the tumult of changing times. Highly recommended...

The power of yes...

Do corporations like BP lie to save money? Is a bear Catholic? Does the pope s*** in the woods?...

Class Act Dept: Now, why would anyone think that the party of David Vitter, Mark Foley, and Voyeur would resort to pornography?...

Wake up, little Susie (and you, too, Lindsay and Holy Joe)...

Brownie, now doing a heckuva job as the Fox News disaster expert...

Using every trick he accuses Obama of (including, incredibly, sophistry), the Rasher gets especially upset by race-baiting, then launches into a race-baiting tirade of his own and recommends solving our problems with "corrective action." Who sounds like a Nazi now, Rash?...

Conservatives can't stop lying about the health care law. I wonder if their insurance policies cover treatment for addictions?...

Holy Joe, Tailgunner Joe -- what's the diff?...

The Heart of Power: The Republicans Take Command

The Heart of Power: Health and Politics in the Oval Office, David Blumenthal and James O. Morone. University of California Press (420pp.)







"The time is at hand -- this year -- to bring comprehensive, high-quality health care within the reach of every American."

Richard Nixon, January 30, 1974

Richard Nixon grew up poor in household headed by a harsh and abusive father. Although he revered his mother, she appears to have been an emotionally aloof, if responsible, parent. A loner in school, Nixon became even more so when two brothers took ill and died from tuberculosis. The presidential personality that emerged from this traumatic childhood was secretive, ruthless, alcoholic, mistrustful, and paranoid. It was also capable of remarkable foresight and visionary strategic thinking. Although remembered for his foreign policy and the stain of Watergate, Nixon also changed the terms of the health care debate.

No doubt Nixon's boyhood experience informed his commitment to health care reform. The last Republican president to think of himself as a government man, Nixon shared Dwight Eisenhower's antipathy to Democratic health proposals based on comprehensive federal government programs. His health policy encouraged the development of HMOs, and late in his administration he proposed health care legislation based on broad insurance via an employer mandate backed by the government. Crippled politically by Watergate and lacking Lyndon Johnson's skills and inclination to work with Congress, Nixon was unable to make headway with his plan to insure all Americans. But the careful policy work of his White House combined with shifting political tides altered the policy discussion. After the Nixon presidency, the health care debate centered on a public-private partnership, not a single-payer government program.

In what served as a harbinger of the future, Jimmy Carter narrowly defeated a weakened Gerald Ford in the 1976 presidential election. An avowed centrist, Carter was the first Democratic nominee since John W. Davis in 1924 to run for president something other than a liberal. Carter grew up in relative luxury in backward rural Georgia, the son of a prominent peanut farmer. He assumed the presidency with no great interest in health policy, other than a conviction based on his upbringing that hospitals overcharged significantly and delivered little. Carter believed that overall public health would improve if more Americans lived as he did, foregoing tobacco and alcohol and maintaining physical condition.

But Carter had made a commitment to the United Auto Workers that he would pursue some sort of health care reform as president. And to Jimmy Carter, a promise was a promise. So, he dutifully assembled a health care task force from within his administration and carefully reviewed the precise details of each proposal, most of which concerned cost containment. Carter's personal attention to detail was prodigious, but he ignored the politics of health care: His White House offered a number of small government cost-cutting proposals that had no appeal to the critical liberal wing of the party. Eventually, differences in health policy helped motivate Senator Edward Kennedy's (D-MA) primary challenge Carter, a challenge Carter beat back only to lose badly to Republican Ronald Reagan in the 1980 general election.

Reagan's election signaled what Blumenthal and Morone call a "tectonic change" in American politics. Until Reagan, the debate between Republicans and Democrats had been over the extent of government's role in the economy, health care, civil rights, and all of the other issues of the day. Reagan questioned whether government should be involved at all, and millions of Americans agreed with him. American life, Reagan argued, had embodied the Puritan vision of the shining city on the hill until government ruined everything by taking people's tax dollars and providing nothing in return other than (he claimed) failed liberal programs.

The son of an alcoholic, a man who let only his wife behind the affable psychological facade he constructed around himself, Reagan had a burning desire to be liked and loved. Late in his administration, the Iran-Contra scandal eroded his popularity and caused many Americans -- especially the elderly -- to question both Reagan's competence and honesty. In part to regain his standing and in part because of genuine concern, Reagan acted against the advice of almost everyone in his administration and proposed a major extension of Medicare that offered catastrophic health insurance funded by a surcharge on Medicare beneficiaries. The Congressional Democratic majority added a prescription drug benefit, and legislation as antithetical to the Reagan Revolution as can be imagined passed into law.

But the new law was never popular with seniors, many of whom already had catastrophic insurance and who resented (or couldn't afford) the surcharge. Congress quietly repealed the bill during the first Bush Administration, an administration headed by a president with a distinct disinterest in health policy. But the growing number of uninsured Americans appeared certain to make health care reform an issue in the 1992 election, and the Bush Administration covered its bases by proposing a plan based on tax deductions for purchasing private insurances; market reform that would address issues of portability and pre-existing conditions; efficiencies achieved by, among other things, use of advanced health information technology (an important part of President Obama's plan); and greater state flexibility (which contained the genesis of the SCHIP plan of the 1990s). Hemmed in by the Reagan deficits, an uncooperative Democratic majority, and his own lack of commitment, George H. W. Bush allowed health policy to drift even as his administration developed ideas that some Democrats took careful note of.

If the economy, stupid, was the most instrumental issue in Bill Clintons's election, then health care, stupid, was a close second. After Clinton's victory, large-scale health care reform seemed such a certainty that Republicans began to develop their own plans based, ironically, on employer and individual mandates. Unfortunately, when it came to health care, Bill Clinton displayed none of the exceptional political skills that came to define his presidency as it matured.

Impressed by the early success of Health Maintenance Organizations in controlling costs, the policy wonk president placed two other policy wonks -- Hillary Clinton and Ira Magaziner -- in charge of writing health care legislation. (To be fair, House and Senate Democrats recommended to Clinton that he present Congress with a finished bill. A more experienced Washington hand might have recognized the folly of this approach, as anything submitted to Congress -- no matter how detailed or broad -- was certain to be publicly dissected and rewritten.)

While Hillary Clinton and Magaziner led hundreds of hours of policy discussion, no one appears to have paid much attention to political exigencies. The pair developed a bill so complex and so aimed at accommodating all interested parties that few understood it and even fewer were happy with the whole. The insurance industry's infamous "Harry and Louise" commercial (actually shown only in one market) went viral, interest groups used individual parts of the bill to attack its entirety, and Republicans moved from offering their own version to outright opposition. The bill collapsed under its own weight and an absence of political acumen. For the remainder of his presidency, Bill Clinton regarded health care reform as toxic and never raised the matter again.

The signal health care accomplishment of the 1990s was the State Children's Health Insurance Program (SCHIP), co-sponsored by Senators Edward Kennedy and Orrin Hatch (R-UT) and designed to cover the uninsured children of low-income families who did not qualify for Medicare. Clinton's successor, George W. Bush twice vetoed legislation extending SCHIP on ideological grounds.
Nonetheless, Bush not only approved other legislation that added a prescription drug benefit to Medicare, he actively pursued it.

History is likely to define the Bush presidency as failure headed by a cocky, overmatched, and incurious man who led the country into a disastrous and pointless war, who bears responsibility for the failed federal response to Hurricane Katrina, and whose ideological rigidness contributed to a near total collapse of the economy. His interest in health care stemmed from a complicated mix of a desire to remake Medicare in a conservative image, awareness of the price paid by his father for ignoring health care, and the childhood death from leukemia of his sister. (Why the latter did not influence Bush when he vetoed an extension of SCHIP is something only he can answer.)

Changes in the practice of medicine emphasized pharmaceutics, and Medicare did not address prescription coverage. Bush, who wanted to completely privatize Medicare, eventually proposed a plan in 2003 to offer prescription coverage to seniors, but only via purchase of private insurance. Nervous about senior reaction to this approach, the Republican Congressional leadership negotiated a compromise with AARP that limited privatization to four competitive demonstrations beginning in 2010, then quelled a conservative rebellion in their own ranks and passed what became Medicare, Part D largely along party lines. It is the largest expansion of Medicare to date.

On this one issue, at least, Bush proved an able and engaged politician. He understood the issue and, although forced to give ground on privatization, ensured passage of a bill that he thought would negate a key Democratic advantage in the 2004 election. And, yet, it did not: Health care reform was firmly established in the collective mind of the electorate as a Democratic issue. Save Jimmy Carter -- and he ran under unique circumstances -- every successful Democratic candidate for president included health care reform as a key part of their platform. In 2008, Barack Obama was no exception.

The Heart of Power concludes its history of health care policy with the second Bush presidency. As Blumenthal and Morone demonstrate, it took nearly 75 years of victory, defeat, and debate for a strategy of successful health care reform to emerge. In the final part of this review, I'll examine the elements of that strategy, its application to Barack Obama's success in passing health care reform, and the underlying political rationale to Obama's decision to work within the existing health care system.

(End Part 3. Next, Part 4: Rules for Success)

Remember to check the New Orleans Ladder for the latest on the BP/Halliburton Oil Spill (aka, Oil Man River)...

JUST A SONG has the story behind the Traveling Wilbury's hit "Handle With Care."

The Heart of Power: Momentum and Medicare

The Heart of Power: Health and Politics in the Oval Office. David Blumenthal and James Morone, University of Californian Press, 420pp.

In all things which deal with people, be liberal, be human. In all those which deal with people's money or their economy, or their form of government, be conservative.

-President Dwight Eisenhower, 1954

Dwight Eisenhower fretted. The 34th president, a man Theodore White once called "the greatest living vote getter," worried obsessively about keeping the federal budget balanced. He worried that the New Deal had encroached on liberty (although privately he ridiculed reactionary attempts to roll it back). As president, the former five-star general cut military spending and famously warned of the political dangers posed by a military-industrial complex. And concerns over the inevitability of a sweeping government health care program gnawed at him enough to encourage members of his administration to explore alternatives.

In general, the health care proposals that emerged from the Eisenhower Administration comprised an unwieldy combination of federal funding, state administration, and private insurance. While these satisfied Eisenhower's insistence on a health care policy that minimized the role of the federal government in the day-to-day administration of the nation's health care, they also created an administrative burden that ran up costs. Administration plans were subject to a convoluted vetting process imposed by Eisenhower's belief in staff work, and usually wound up watered down by compromise and by the negative reaction of budget experts who insisted that broad health care reform would never pay for itself. Moreover, the proposals were never received with any great enthusiasm by the barons who ran congressional committees.

The Revenue Act of 1954, passed by a Democratic Congress and signed by Eisenhower, formalized and expanded an obscure World War II regulation that rendered tax free health care premiums paid by employers and employees. Although little remarked on at the time, the bill enabled the expansion of the private health care market because employers began offering the tax free benefit to employees. (Fatefully, Walter Reuther of the United Auto Workers proposed a cross-industry health care benefit that the Big Three, fearing a concentration of union power, opposed. They proposed and negotiated a separate deal with the UAW, a proposal that haunts them to this day.)

A second major advance for private insurance came with 1959's Federal Employee Benefits Program, a congressional proposal to offer health insurance to federal employees. Since the insurance came from private ensurers, Eisenhower readily acquiesced to a program that became the model for Barack Obama's health care promise during his 2008 campaign. The plan proved that the federal government could run a large privately administered, market-based benefit.

Eisenhower was a deeply humane man, but when it came to health care, his personal magnanimity often found itself in conflict with his public parsimony and skepticism of government. His interest in health care was personal: The lingering death of his mother-in-law had visited financial ruin on that family. Thus, his health care presidency centered on reconciling Eisenhower's personal experience with his philosophy of limited government. Although this led to no legislative breakthroughs, it resulted in the initial Republican alternative to the Democratic preference for government programs, led to the increase in the number of Americans with private insurance, and revealed a key truth for future presidents who would pursue health care reform.

Under Eisenhower, the role of private health insurance expanded to such a degree that by 1960 more Americans had health insurance than did not. Fearing the inevitability of an expansive government plan, his administration articulated a Republican alternative based on federal, state, and private insurance cooperation. And it uncovered a key rule for future presidents: Minimize the role of the bean counters. Pursue health care reform because you think it is the right policy, and don't give ammunition to opponents who want to make it a matter of cost.

The first president of the television age, John Kennedy inaugurated the era of the charismatic presidency. As president, Kennedy brought the unfathomable trait of charisma to bear on the domestic issue that preoccupied him most: Health care. Despite his cool, detached public exterior, Kennedy had a finally honed sense of fairness that revealed itself when his father suffered a debilitating stroke. My family can afford to pay for the best care, Kennedy reasoned, but most cannot. And so the Kennedy Administration put its weight behind Medicare, the federal health insurance program for the elderly.

Dwight Eisenhower's so-called hidden hand presidency had rendered him invisible when it came to health care policy. The Kennedy team decided instead to put the president's considerable public appeal front and center while also working an inside game with Congress. Kennedy delivered a series of speeches supporting Medicare, culminating in a nationally televised address at Madison Square Garden. On the stump, he found an effective rejoinder to the American Medical Association's tired warnings of socialized medicine: Opposing Medicare was no different than opposing Social Security.

But Kennedy's effort preceded the 24-hour news cycle and had little effect on the representatives and senators who controlled the legislative fate of Medicare. Moreover, the Administration had no effective, unified plan for dealing with Congress. When the senate narrowly defeated Medicare, Kennedy found himself denouncing this "most serious defeat for every American family."

Historians will long debate the unfinished promise of John Kennedy's presidency. Medicare had became personal to him, and a sweeping electoral victory in 1964 might well have prompted him to revisit it. We do know that his successor, the man Blumenthal and Morone call "the greatest inside player of the twentieth century" achieved the historic breakthrough that eluded Kennedy. But even in defeat, Kennedy taught future presidents a valuable lesson: Passing major health care legislation requires a full court press, a total commitment from the president, something that Kennedy's successor understood in his bones.

"A man's vision reflects his memories," wrote Lyndon Johnson, and Johnson's memories included a hard-scrabble youth, teaching school in one of the poorest parts of the country, and working as a young New Deal administrator during the heart of the Great Depression, when -- as he later observed -- he discovered that for too many people Christmas was just another day of poverty and misery. To Lyndon Johnson, government was a tool for helping the American people, to facilitate what he termed a Great Society that would, among many other things, end once and for all the problem of inadequate health care for the elderly.

The master of Congress, a former Senate Majority Leader, knew how to work the legislative branch: Relentlessly and without letup. The standard history of Medicare suggests that in 1965 Rep. Wilbur Mills (D-AR), the conservative House Ways and Means Committee chairman who had made a habit of making his committee the place where health care reform went to die, underwent a sudden conversion and reported a comprehensive Medicare bill out of his committee. But research by Blumenthal and Morone into heretofore unavailable resources reveals that Johnson negotiated with Mills for over a year and played an instrumental part in bringing a divided Congress around to support Medicare legislation.

The bill itself knit together three proposals: An Administration bill to pay hospital costs for the elderly via Social Security, a Republican proposal to pay physician costs, and an AMA plan to cover costs for the poor and the near-poor (Medicaid). Johnson never concerned himself with the details and expressed anger whenever the costs of the legislation came up: He knew what a deal breaker this could be to a service that he thought as fundamental to the American home as coffee and flour. Pass the bill, he said; I'll find the money.

Lyndon Johnson had the wind at his back. He was taking up the cause of a martyred and popular president and had just won a landslide reelection. He knew Congress and its members like the back of his hand, and he knew how to pass legislation. Johnson pulled every stop that he knew, and Lyndon Johnson knew a lot of stops. And even so, Medicare was near thing: The Senate passed it by a 49-44 vote; even after passage, implementation was uncertain.

Would southern hospitals integrate? Administration pressure and a reluctance to decline Medicare largesse ensured that they did. Would doctors boycott Medicare patients? Johnson's personal intervention and negotiation brought them around. Would hospitals be able to handle an influx of patients? In the event, they did.

The most successful health care president of the 20th Century left his successors with a blueprint for health care policy success. His personal commitment was total and he worked with alacrity. Johnson steered clear of policy details and focused on creating political momentum. He understood how to deal with Congress, readily grasped that spectacular reelection had given him the upper hand, and passed out credit like Halloween candy. And, as counterintuitive as it seems, Johnson kept his economists in check.

Lyndon Johnson's great legislative year of 1965 remains one of the high water marks of American liberalism. But his immense popularity foundered on the Vietnam War and the riots of the mid-60s. These events tarnished Johnson's presidency and opened the door to a president whose troubled, byzantine mind contributed to forcing him from office. But unlike today's conservatives, Richard Nixon thought of himself as a government man, and the experience of a painful childhood opened opened his complex mind to the possibility of extending health insurance to all Americans.

(End Part 2. Next, Part 3: The Republicans Take Command.)

As has been the case from the spill's onset, the New Orleans Ladder remains the best internet source for news and accounts of the BP/Halliburton Oil Spill...

The Heart of Power: Stirrings

The Heart of Power: Health and Politics in the Oval Office. David Blumenthal and James A. Morone. University of California Press (420pp).
When Franklin Roosevelt became president in March, 1933, he led a nation that was, as he later said, one-third "ill-housed, ill-housed, ill-nourished." He might well have added ill-cared for, as the nation's health infrastructure was skeletal to say the least. Nascent efforts at health insurance had begun four years earlier with the first Blue Cross organizations, public hospitals were few and often segregated, and widespread treatment of illness via pharmaceutics remained well into the future. Indeed, so little was known about the treatment of serious illness that Roosevelt himself had devised rehabilitation for his polio based on the natural hydrotherapy of Warm Springs, Georgia.

It was against this backdrop that members of Roosevelt's early New Deal made the first serious proposals for national health insurance, and it's here that The Heart of Power: Health and Politics in the Oval Office, David Blumenthal's and James A. Morone's essential book about the politics and development of American health care policy, begins. Because of the scope and impact of an issue such as health care, the momentum to achieve reform must come from the Oval Office. Blumenthal and Morone cover the approaches of eleven administrations from Roosevelt to the second Bush with an unexpected twist: They examine the health history of each president for clues to his health policy.

In the course of their research, the pair uncovered a number of surprises. These include the extent of Lyndon Johnson's involvement in Medicare, which was much greater than previously thought, and the policy grasp and political skill brought by George W. Bush to the enactment of Medicare, Part D. Further, they demonstrate that while the Democratic party successfully kept the issue alive across several political generations, the Republicans eventually defined the terms of the debate so effectively that Barack Obama had little choice but to adopt what had once been the lynchpin of conservative thought about health care. That today's Republicans fought him so ferociously only proves the extent to which they moved the debate to the right, a process started by Ronald Reagan and consummated by George W. Bush.

Roosevelt inherited a nation on its knees. He came into office determined to use government as a vehicle for economic recovery, and he was visionary enough to seek ways of cementing economic security into place. The most lasting of these is, of course, Social Security, which he signed into law in 1935. Three times, members of his administration presented FDR with proposals to extend his legacy by way of universal health care, and three times he demurred. In 1934-35, Social Security and the many New Deal programs for economic recovery took priority: Roosevelt would not be the first president to determine that health care reform, while an important need, was not the most important.

His staff tried again in 1937, but by then Roosevelt's court packing plan had eroded his political standing. Moreover, the southern conservative Democrats who comprised a key part of the New Deal coalition sensed that universal health care meant integrated hospitals and objected to government-based program, as did the American Medical Association (AMA), which at the time was a powerful lobby. The AMA's cry of "socialized medicine" became a familiar refrain adopted by one opponent of health care reform after another.

During World War II, a shockingly high number of draft rejections on health grounds prompted administration health care experts to once again recommend health care reform, this time as matter of national security. Roosevelt included the "right to adequate medical care" as part of the economic bill of rights that formed the core of his 1944 reelection campaign, and a bill even made its way to Congress. But Roosevelt himself put his finger on the fundamental problem: "The only person who can explain this medical thing is myself," he said. And conducting World War II consumed all of the ailing president's energies. For a third time, Roosevelt passed.

In the end, circumstance and a lack of engagement with a complex issue conspired to prevent Franklin Roosevelt from pursuing health care reform. But the issue had been raised and raised persistently enough to gain a foothold in the Democratic party. And the failure of the New Dealers to persuade their own president to push seriously for health reform revealed a significant principle for future success: The absolute necessity of the president's prolonged and public commitment to the issue.

Harry Truman, FDR's successor, was an obscure Missouri politician who had been a compromise choice for vice-president. Though personally likable,  Truman seemed ill-prepared for the job of replacing the most iconic president since Abraham Lincoln, a man trusted and beloved by the American people. Most expected a caretaker presidency; Truman surprised the country by turning out to be a fiery liberal with a penchant for quick, intelligent assessment and willing decision-making. He  lead the country through the tumultuous post-war period with partisan fearlessness, developing a major presidency that, among many other things, exposed health care as a potent political issue.

Truman's passion for health care, for that's what it was, drew from his experience in the rough-and-tumble of Missouri politics. He saw a system that took care of the very wealthy and the very poor while leaving the middle class to its own devices. Moreover, he, too, had been shocked by the physical unreadiness of many men for military duty in a time of national crisis. Truman spoke to Congress of the idea of national health insurance immediately after the end of World War II, and became the centerpiece of his extraordinary 1948 campaign:

What did the Republicans do with my proposal for health insurance? You can guess that one. They did nothing. All they said was-- "Sorry, we can't do that. The medical lobby says it's un-American." And they listened to the medical lobbies in Congress.

I put it to you. Is it un-American to visit the sick, aid the affected, or comfort the dying? I thought that was simple Christianity. Does cancer care about political parties? Does infantile paralysis concern itself with income?

Never had a president spoken so passionately about health care; it resonated with voters, and helped return Truman to office in an election that no one other than Harry Truman thought he would win.

But once back in office, Truman never pushed seriously for national health insurance, and the reasons remain elusive. Certainly, any chance of serious reform disappeared in 1950 when the Democrats lost their Congressional majority for the first time since the Depression. Other events bedeviled the Truman Administration, including labor troubles at home and foreign policy crises in Greece, the Middle East, and Korea. Reorganizing the presidency itself, which the Depression and the war had transformed into a sprawling bureaucracy at the heart of American politics, proved difficult and time-consuming. And Truman was, by his own admission, often maladroit in public appearances, when championing this issue called for near perfection.

Harry Truman believed that the gravitational force of history created a progressive tide of events that would inevitably include health care insurance coverage for all Americans. He did not anticipate the direction from which it would come, but his passion on the stump cemented health care as a signature Democratic party issue, proved its political power, provoked the Republican opposition to developing an alternative, and ensured that health care reform would not disappear from the public consciousness....

Next: Part 2 (Momentum and Medicare)

Day of Reckoning: Demographic trends indicate that by 2050, whites will make up a plurality of less than half of American citizens, about 47% of the population. Moreover, whites will be older than other Americans, meaning that young minority workers will support aging whites with payroll taxes. I only wish that I could be here to see the s*** hit the fan...