O’Neill Institute for National and Global Health LawO’Neill Institute for National and Global Health LawLegal Issues in Health Reform

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Battle in the Bureaucracy: An Interview with James Morone, Part I

James Morone is professor of political science at Brown University. His most recent book, co-authored with David Blumenthal, is The Heart of Power: Health and Politics in the Oval Office. This is the first of a two-part interview.

James Morone: There is something unique—and, to me, alarming—about this health reform process. Normally in our political system, when we have enormous battles over legislation, most political actors consider the politics done when the legislative battle is over. What’s new here is the idea that the battle goes on into the implementation phase. This wasn’t true for Social Security, it wasn’t true for Medicare, it wasn’t true for civil rights. Of course, interest groups always continued to fight to get the best deal possible in implementation. But that’s very different from it being Democrats versus Republicans or liberals versus conservatives. Today’s situation is very different.

Given how difficult implementation is, to have the politics continue both in the courts and bureaucracy really makes you worry about the American political process as a whole and this health reform in particular.

Lester Feder: When you talk about the politics continuing, what specifically are you referring to?

James Morone: For starters, the legal challenge—that casts a shadow over the whole business. It’s also the impression that the Republicans have vowed to battle this in the bureaucracy as well. I haven’t seen the details, but if that’s true, it’s really unprecedented.

Lester Feder: What would a battle in the bureaucracy look like?

James Morone: Usually, policymakers have to make two kinds of judgments: what’s going to make this happen most efficiently, and how to buy off the interest groups so that they’ll participate. Now you have a whole other set of players—particularly the state governments—who have very central role in this and are in the process of suing the legislation to stop it from going into effect. If 20 states—40 percent—try to resist reforms, there are a lot of opportunities for them to do so.

Lester Feder: Is that a symptom of the political process that produced the legislation not working in the first place?

James Morone: Yes. I think it’s a symptom of the quite extraordinary division at least in Washington between the parties, particularly the passion of the Republicans. I’m not sure the Democrats have been quite this insistent after losing legislation. To have the Republican Party be this forceful about a position after the normal political process has run its course is pretty extraordinary.

Lester Feder: Looking at the history of passing of major legislation, while there may not have been stark partisan divisions, there were ideological divisions—if you counted conservative Democrats—that were as close as what produced health reform. Is there something special about it being a partisan division?

James Morone: I think if you look at Medicare, there was no fiercer debate between the end of World War II (when it was about national health insurance) and 1965 when the bill passed as Medicare. Senators Bob Taft (R Ohio) and James Murray (D-Montana) almost came to blows in committee hearings.  There was the first major interest group campaign against a specific piece of legislation. There were cries of socialism right in the middle of a red scare. It was as intensely as partisan as one could imagine.

In the original vote in the House, the legislation passed by some 45 or 46 votes. It got exactly 10 Republican votes in the House. But that was on a preliminary vote on a parliamentary maneuver to stop it from being buried back in committee. When that vote failed, almost all Republicans then crossed over and supported Medicare. Going into implementation, the parties had basically agreed that the battle was over and the liberals had won.

Lester Feder: Why did the Republicans change their votes?

James Morone: The thinking was that they had lost, and they wanted to take credit for legislation that was likely to become popular. This was not an unusual maneuver in an earlier era. Social Security was the same way. The signal to the partisan sides was, “Ok, the politics is now over and we should close ranks around this legislation.”

Lester Feder: When did this stop being common?

James Morone: In health care, the answer is now, with this legislation. As far as I can see, we’ve crossed a kind of boundary line where the idea that the legislative process marks the end of politics between parties and ideology. I think this is the first time that I know where the battle continues essentially unabated. I think this is a really important event.

Lester Feder: Let me push you a little bit on that. In 2006, several Democratic campaigns were running against Part D. How is that different?

James Morone: I don’t know of any effort to bollocks up the implementation of Part D. While Democrats were outraged and ran against the program, they didn’t to sue to stop it, nor was there the sense that they were going to fight it in a campaign in the bureaucracy. People always run to put stuff back into the political process. What’s new is the suggestion that the fight go beyond Congress.

2 Trackbacks

  1. […] seen partisan politics break out over past social reforms, never before has the partisan rhetoric extended into implementation: Normally in our political system, when we have enormous battles over legislation, most political […]

  2. […] bill they opposed, they would simply switch their votes and take credit for it. For instance, in that interview with Lester Feder, James Morone recalls how “in the original [Medicare] vote in the House, the legislation […]

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