Turning Points In U.S. Health Care

GUY RAZ, host:

Now, if health care overhaul does become law by the end of the week, historians say it'll become one of the most consequential pieces of domestic legislation in modern history, the biggest change in health care since Lyndon Johnson created Medicare and Medicaid back in 1965.

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President LYNDON JOHNSON: No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.

RAZ: That's Lyndon Johnson, signing Medicare into law in 1965.

James Morone studied that fight and wrote about it in a book he co-authored, "The Heart of Power: Health and Politics in the Oval Office." He teaches political science at Brown University. And he joins me now.

Welcome to the program.

Professor JIM MORONE (Co-author, "The Heart of Power: Health and Politics in the Oval Office"; Political Science, Brown University): Hi, Guy.

RAZ: Put this into context for us. If the Democrats' health care bill does become law this week, where does it fit in American political history?

Prof. MORONE: In my view, it's huge. The great bills in social policy in American history are: first, Social Security, passed in 1935; then Medicare and Medicaid in 1965. In my reading, this is number three behind that. It's that big.

RAZ: Now James Morone, after Medicare was created in the mid-'60s, how long did it take before people actually felt its impact?

Prof. MORONE: Very quickly. Medicare went into full effect in one year. Lyndon Johnson wrote in his autobiography that this was the largest mobilization of public resources since D-Day, since the launching of the invasion of Normandy. And most historians think that is not an exaggeration.

RAZ: Now, I mean, one of the major differences between then and now is that Lyndon Johnson did actually manage to get some Republican support for Medicare.

Prof. MORONE: In the actual first vote on the House floor, 10 Republicans, count them 10, voted for Medicare. The rest voted against it. But they didnt vote against Medicare. They voted against the parliamentary maneuver so that once it was clear that parliamentary maneuver was going to fail, they all switched votes. So in effect, the Republicans voted for it after they voted against it.

The great difference today is no Republicans are switching their vote.

RAZ: Yeah.

Prof. MORONE: So should this program five years from now prove to be very popular, the Republicans who fought so hard against it could find themselves in a quite tricky situation.

RAZ: Well, I want to ask you about that because one of the ironies today is that Medicare is almost universally supported in Congress, as is Social Security, by both parties. And like Social Security, Medicare is often referred to as the third rail of American politics, almost untouchable.

Is it possible in your view that the same thing could eventually happen to this plan that's being introduced?

Prof. MORONE: I think it's not only possible but likely. Most health care legislation in the United States, even very contentious at passage, proves to be quite popular. Even George Bush's prescription drug plan, passed in 2003, and the subject of enormous politics and denunciations from the Democrats, who were in the minority then, has proven, with time, to be very popular.

So if the past is any guide, five years from now, this is likely to join those other programs as very highly popular.

RAZ: And, James Morone, I don't want to overstate it, but can this week, what's going to happen this week and everything riding on it for President Obama, can it make or break his presidency from a historical context?

Prof. MORONE: I think it's very likely. I don't think you're overstating it at all. I know of very few cases where a president has put so much on the line on one vote, one role of the dice.

Look, if Obama loses this vote, he becomes, basically, a very weakened president. He becomes Jimmy Carter. If he wins this vote, he becomes larger than life. So I think future historians will look back on today and say that was a watershed in American history.

RAZ: There's also a possibility, of course, that they may look back and say that it was a disastrous moment.

Prof. MORONE: Yes, if this legislation proves unworkable or unpopular, and it goes through, the Democrats are out there all alone on a limb. If the legislation loses today, Obama, having spent every bit of political capital he's got, well, he's got no political capital left. Imagine the next time he goes to someone and says I need your vote? Get away, they'll say. Everything for the Obama people is at stake in, first, what happens today and, secondly, how this legislation works.

RAZ: That's James Morone. He's a political scientist at Brown University and the co-author of the book "The Heart of Power: Health and Politics in the Oval Office."

James Morone, thank you so much.

Prof. MORONE: Thanks, Guy.

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