Got this from Just One Minute blog. Interesting to contrast the
Medicare passage and the debacle this administration is making of the
Healthcare Reform Bill. Another point that is not mentioned is that
Johnson, for all his faults, could work and did work with Dirksen and
Halleck, the Minority Leader of the Senate and House, for the good of
the country. I sure don't see that happening with our "pragmatic"
president today.
March 17, 2010
Tough Votes! (Or, Is There Any DNC Talking Point Too Absurd For
Ezra Klein To Parrot Happily?)
<http://justoneminute.typepad.com/main/2010/03/tough-votes-or-is-there-any-dnc-talking-point-too-absurd-for-ezra-klein-to-parrot-happily.html>
Ezra Klein delivers a laugher
<http://voices.washingtonpost.com/ezra-klein/2010/03/was_medicare_popular_when_it_p.html>
on healthcare reform; Megan McArdle
<http://www.theatlantic.com/business/archive/2010/03/polling-medicare/37599/>has
already spanked him, but why should she have all the fun?
Over to Ezra:
For some time, I've been trying to find good polling from the
passage of Medicare. According to Greg Sargent, though, the
Democrats beat me to it
<http://theplumline.whorunsgov.com/health-care/dem-leaders-to-rank-and-file-public-was-closely-divided-on-medicare-too/>
For about fifteen seconds I tried using Google to find good polling data
on the passage of Medicare. For folks feeling lucky, here is the top of
the list from my first search
<http://www.google.com/#hl=en&source=hp&q=gallup+poll+medicare+1965&btnG=Google+Search&aq=f&aqi=&aql=&oq=gallup+poll+medicare+1965&gs_rfai=&fp=f8bc9ba0718e9555>,
on "gallup poll medicare 1965":
Health Care Reform Circa 1965: Polling on Medicare
<http://voices.washingtonpost.com/behind-the-numbers/2009/07/health_care_reform_circa_1965.html>
My goodness, that is from Ezra's very own Washington Post back in July
of 2009, now being recycled by those intrepid sleuths at the DNC.
Ezra concludes his excerpt with this:
After Lyndon Johnson was elected, a Harris poll found only a
minority, 46%, supported a Federal plan to extend health care to the
aged. Today, of course, Medicare is overwhelmingly popular.
Had Ezra read on, he might have found a bit more context:
Following Pres. Lyndon Johnson's election, Americans remained
somewhat divided on the plan, with 46 percent telling Harris
pollsters in Feb. 1965 that they'd prefer "a Federal law which would
provide medical care for the aged by a special tax, like Social
Security" and 36 percent more inclined to support "a plan of
expanded private health insurance."
Hmm, Medicare was more popular than a private alternative. DId Ezra
know that and just forget to pass to on, or is this Book of Revelation
time? Let's soldier on for more surprises:
Asked another way, 62 percent said they favored "President Johnson's
program of medical care for the aged under Social Security." A
smaller majority, 56 percent, backed the American Medical
Association's alternative plan, which would have "everyone who could
afford it covered by private health insurance" and "those who
couldn't afford it ...covered under a government health plan."
Assessing these conflicting views, pollster Louis Harris concluded,
"So deep is the concern about medical care for the aged that the
American people would welcome any of a variety of national plans."
So asked another way there was still more support for Medicare than the
private alternative.
Let's cut to Ezra's punchline:
I wonder how many of the legislators who took the tough vote to move
Medicare forward regret doing that today.
The tough vote! A bit more research (I cleverly went with "medicare
senate votes 1965
<http://www.google.com/#hl=en&q=medicare+senate+votes+1965&aq=f&aqi=&aql=&oq=&gs_rfai=&fp=bf62906be5292fd6>"and
took the first result <http://www.ssa.gov/history/tally65.html>) shows
us that Medicare passed the House in April by a tough vote of 313-115
and went to the Senate where a similar bill wheezed through on July 9 by
68-21. The House-Senate conference reported a bill on July 26 and the
final product cleared the House by 307-116, the Senate by 70-24, and was
signed into law on July 30. Hey, in time for the August recess, just
like Obama wanted!
Some Times story mentioned that the bill cleared the relevant Senate
committee by a tooth-pulling 12-5. As to bipartisan backing, the final
bill was supported by a majority of House Republicans (70-68) and 40% of
the voting Republican Senators (13-17).
Well. I wonder how many of the lefty bloggers who took the tough
decision to move this DNC talking point forward regret doing that today.
DARN THAT PESKY CBO: This New England Journal of Medicine history
<http://content.nejm.org/cgi/content/full/359/22/2384> of the passage of
Medicare includes this lesson:
Johnson did one more crucial thing over the course of the winter^
and spring of 1965: he managed the economics of the Medicare^ and
Medicaid legislation. This was much easier to do in 1965^ before the
creation of the Congressional Budget Office, which^ now provides
independent economic reviews of all legislation,^ and a similar
office within the White House, the Office of Management^ and Budget.
But it was still necessary then, as now, to confront^ arguments that
expansions of health care coverage were unaffordable.^ To do this,
Johnson detailed loyal aides, including Cohen and^ Treasury
Department personnel, to work quietly with legislators^ on designing
taxes and benefit packages. When Mills still expressed^ concern
about the costs of adding Part B and Medicaid to the^ Medicare
package in March 1965, Johnson told him not to worry:^
I'll take care of that, I'll do that. . . . When they asked^ me,
do you want to put in another 400 or 500 million [to cover^
Mills's Medicare expansion], . . . what did I say about it?^ . .
. I said we had an old judge in Texas one time . . . we^ called
him Al Caldy . . . old Al Caldy Roberts, and he said,^ when they
talked to him one time that he might've abused the^ Constitution
and he said, "What's the Constitution between friends?"^ And I
say, tell Wilbur that 400 million's not going to separate^ us
friends when it's for health. . . .^22
<http://content.nejm.org/cgi/content/full/359/22/2384#R22>
^
Cavalier as Johnson may sound here, especially in light of the^ huge
subsequent costs of these programs, his comments signal^ an
unpleasant reality worth pondering: Johnson underestimated^ the
numbers and evaded economic projections to smooth the passage^ of
Medicare and the rest of his Great Society program. An accurate^
economic forecast might have sunk Medicare. Moreover, Francis^
Bator, a national security aide to Johnson at the time, recently^
asserted that during 1965 Johnson also suppressed news of the^
escalation of the Vietnam War and its attendant costs so that^
Congress would not question whether the nation could afford^ the
president's Great Society initiatives
And the lesson:
Sixth, the most heretical generalization to emerge from the^
historical experience may be the following. The expansion of^ health
care to large populations is expensive, and presidents^ may need to
quiet their inner economists. Johnson decided, in^ effect, to expand
coverage now and worry about how to afford^ it later. Accurate cost
estimates might very well have sunk^ Medicare. In fact, this
generalization holds across every administration^ from Harry Truman
to George W. Bush. Major expansions of health^ care coverage rarely
fit the budget and generally drew cautions^ (and often alarms) from
the economic team.^24
<http://content.nejm.org/cgi/content/full/359/22/2384#R24> Of
course, under^ current federal budgetary circumstances, managing the
economics^ of health care reform may be more difficult than ever before.
Posted by Tom Maguire on March 17, 2010 | Permalink
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