Friday, May 15, 2009

Lyndon Baines Obama?

This week’s White House meeting between President Obama and a coalition including insurers, the Pharmaceutical Research and Manufacturers of America, physicians, hospitals and others on health reform reminded us of how another president used his PR skills and White House platform to push a key health issue forward in the direction he wanted.

In 2009, the industry groups came to the White House with the idea of expressing their commitment to health reform and to contribute their share toward a goal that health reform would eventually save as much as $2 trillion over 10 years.

Somehow, by the time they got home, there was a widely reported perception that the associations agreed specifically to reduce their costs to the health system by $2 trillion. The president asked them to come back in June with proposals for how they will do this. Since then, there has been a bit of backpedaling, and differing reports of whether the President misspoke in describing their agreement (see the full account in the May 18 issue of “The Pink Sheet”).

Now, we’re not sure how the confusion arose or who is spinning who. But we wonder if Mr. Obama learned a few presidential wiles from Lyndon Johnson and Medicare. LBJ managed to push through legislation creating the Medicare program in July 1965, despite vociferous opposition from the American Medical Association. He knew the program would never get off the ground without physician support. Here’s how he got it, as recounted by historian Robert Dallek in Lyndon B. Johnson, Portrait of a President:

Some members of the Administration were so worried about winning the cooperation of the AMA that they urged a meeting at the White House with AMA leaders at which the President appealed to doctors to support a law favored by the people and worked out “in the most pain-staking way in accordance with the exacting rules of our democracy.”

Johnson did not think that the AMA and most physicians would find it easy to oppose Medicare without serious damage to their public standing. But he was worried enough to invite AMA leaders to the White House, where he could compel a public acknowledgement of their support. In a July 30 discussion with eleven AMA officers, Johnson asked the physicians for help in getting doctors to rotate in and out of Vietnam for a few months to serve the civilian population. Appealing to their patriotism, Johnson declared, “Your country needs your help. Your President needs your help.” The doctors responded almost in unison with promises to start a program immediately.

“Get the press in here,” Johnson told [presidential Press Secretary Bill] Moyers. When they arrived, Johnson described and praised the AMA’s readiness to help the Vietnamese. But the reporters, undoubtedly primed by Moyers, wanted to know whether the doctors would support Medicare. Johnson, with mock indignation, said: “These men are going to get doctors to go to Vietnam, where they might be killed. Medicare is the law of the land. Of course they’ll support the law of the land. Tell them," Johnson said, turning to the head of the delegation. “Of course, we will,” the AMA president responded….A few weeks later, the AMA announced its intention to support Medicare.

We just hope Obama doesn’t have any appendectomy scars to show us.

- Denise Peterson & Cathy Kelly

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