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 II

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 second of a two-part interview.

Lester Feder: You argue that the ongoing fight against the health reform legislation in the courts and in the bureaucracy during implementation marks a break from a longstanding political tradition that politics end when legislation is passed. Why do you think this has happened now? Is it simply because our politics have become so bitterly partisan?

James Morone: There are two explanations: One is exactly what you said, that our politics have so become bitter. But secondly, I think somewhere between Reagan, who did it with a smile, and Newt Gingrich, who did it with a scowl, the Republicans have defined the Democrats as basically un-American and bad for the nation. It has taken on a kind of moral fervor against liberals. That makes legitimate a battle that in previous generations would have been outside the bounds of normal politics.

Lester Feder: And yet at the same time, Obama remains the most popular in the country relative to other politicians. How is that possible?

James Morone: That raises a whole other question: How did Obama do it? I think Obama’s incredibly success has gone under the media’s radar—the story lasted only two weeks in the media, and then replaced with a story line about dropping poll numbers. But it is remarkable that he got this bill trough under such partisan circumstances. This is a very important point and I want to underscore it.

If you just look at the history of trying to pass health reform—Truman, Kennedy, Johnson (who succeeded with Medicare), Nixon, Carter, Clinton—it is a remarkable group of people who tried to pass sweeping legislation. The broad consensus in Washington was, as Lee Hamilton told me at one point, “The reason we can’t do it is that health reform is non-incremental, and Congress is an incremental body.” The wisdom always was that it can’t be done. Obama and the Democrats, and you have to underscore Pelosi here, too, they managed to do it. (I would put Reid third on the list—he certainly had a less dramatic and visible role as Pelosi and Obama.)

Lester Feder: Given the bitter history of health reform, could there have been a different scenario? Might it just be in the nature of the issue that no matter who passed it, we would see an equally bitter aftermath?

James Morone: I think it’s symptom of our political climate more than the difficulty of the issue, simply because Medicare was fought just as hard, but the implementation of Medicare for all its problems went through relatively easily.

Lester Feder: Let me just counter here: Medicare touched a smaller segment of the population and a smaller portion of the economy, in terms of the percentage of GDP health care represented. It was a much smaller piece of legislation, in that sense. If the current health reform touches most everybody in some way and accounts for 16 percent of the economy, is it possible that as the problem gets bigger, the politics get more bitter?

James Morone: That’s right, a much smaller percentage, I’m guessing six or seven percent, if that. In sheer economic terms, it was much smaller, but there were worried about the economic effects. But remember, implementation of Medicare got tangled up with civil rights through the desegregation of Southern hospitals. If you put together the two largest and boisterous issues of the time, that ups the ante again.

Lester Feder: Ok, but on the flip side, I find it hard to believe that America is more divided today than it was during desegregation.

James Morone: It’s very hard to sort out how much is the issue and how much is the current situation. I think that by and large the parties today see each other as illegitimate actors. Republicans see Democrats in some fundamental way as un-American. The reason that’s different today is that, in the past, the two parties overlapped a lot. Southern Democrats were more conservative than Northern Republicans. The divisions didn’t map onto party politics—they never have, because the parties were so overlapping. That’s no longer true. The most liberal Republican in the House today is still to the right of the most conservative Democrat. As far as I know, that’s never been true, and certainly not since the civil war. Add that on top of the scope and seweep of health reform, and you’ve got a very combustible kind of politics.

Lester Feder: Do you see a path to resolving these issues? If the Republicans don’t win an overwhelming landslide in 2010, does that settle it? Or is this going to continue under any circumstances?

James Morone: Regardless of the size of the Republicans’ victory—short of having a veto-proof majority, which seems highly unlikely—implementation goes steadily along. Then the question becomes, how effective is the legislation that they put together?

Lester Feder: I spoke with William Sage the other day. Although the political process was successful in that it managed to pass legislation, he felt it was a failure the really large questions about “social solidarity”—the sense that would get Americans to invest in a collective system—were not resolved in the debate. We got legislation through without building public consensus for it. The Obama administration has the power to implement it, but does that lingering lack of consensus threaten to destabilize health reform and politics more broadly?

James Morone: Yes, I think that’s a shrewd point. Here’s how I would put that: There are two kinds of rhetoric that came out around health reform. One form of rhetoric has to do with the specifics of the legislation, and Obama and his administration really blew that until the special election in Massachusetts. At that moment, Obama really kicked his narrow rhetoric around the legislation into gear in a really remarkable way. I think political scientists will be studying that rhetoric for years to come: he talked about people who were sick, he talked about people who were denied health insurance, he stood next to people who were in trouble and said, “We have to support these folks.” At he last minute, when all Democrats were all willing to back off, he rallied the party and gave them cover through brilliant rhetoric. Narrowly, around health reform, he did what he probably should have done months earlier.

What was missing in all this—and it’s been missing in the Obama administration—is a larger framework about the kind of country we have. I go back to Ronald Reagan. During his inauguration, he very simply said government is no longer the solution. We’re a country of individuals, government is the problem.

That turned the page on the rhetoric of John Kennedy, Lyndon Johnson, and Franklin Roosevelt, all of whom projected an image of a nation where people helped each other out. “These dark days will be worth all they cost us if they remind us that our true purpose is to minister to ourselves and to our fellow man.” That’s Roosevelt in his first inaugural address. These are two great rhetorical traditions.

What I’ve been waiting for Obama to do is to say, “Reagan was a great president, but he was wrong about his basic view of America.” He did it during the campaign during the whole debate with Joe the Plummer about “spreading the wealth around.” I sat in vain, almost in tears during his inaugural address, waiting for him to say, “We’re going back to an earlier vision of what America is: a place where we pick one another up when they fall down.” He still hasn’t done that.

While he’s won health reform with rhetoric about health, but he hasn’t painted a larger picture of America that frames health reform and makes people sheepish about saying, “I think this reform makes me worse off, so the hell with it.” Roosevelt would have said, “That’s selfishness, and that’s what got us into this fix, and if you keep on being selfish, we’ll never get out.” I’m baffled why Obama hasn’t done that, because more than any other president we’ve had, he’s got the rhetorical gift.

He’s got the heart, the brain, and the tongue to do this, but he seems relentlessly to refuse to present us with an alternative philosophy to Reagan’s philosophy of individualism. We don’t have a sense of American identity that gives logic to health reform that helps some people more than others. Though I admire what Obama’s done, I can’t understand why he hasn’t presented his understanding of what America is.

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  1. […] goes on to explain why he thinks this is in parts I and II of Lester’s interview (both of which are very much worth reading), but I just want to […]

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