James Morone
James Morone - 
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Kai Ryssdal: Forty-four years ago today President Lyndon Johnson signed a piece of legislation that at the time nobody ever thought would've gotten done. Medicare: government health insurance for people over 65. Presidents before Johnson, and since, have struggled with health-care reform. Brown University political scientist Jim Morone tells that story from FDR to George W. Bush in his new book "The Heart of Power." It's part biography, part health-policy paper, and Morone wrote it, he said, mainly because health and illness are pieces of policy that all presidents can relate to. Not that that made changing the health-care system any easier.

Jim Morone: Health reform has always been incredibly, excruciatingly difficult. Harry Truman made it the great cause of his life, and got slaughtered in Congress. Truman's advisers finally suggested that he back off a national health insurance and just focus on the elderly. That was the beginning of Medicare. And liberals pushed from 1952 right through 1965 to try to get Medicare.

Ryssdal: What was Lyndon Johnson's strategy? How did he go about it?

MORONE: You know, Kai, the standard story about Medicare is that Wilbur Mills, the great ways and means chair from Arkansas, had blocked Medicare for year after year. But after the 1964 landslide Wilbur Mills changed his mind, and at the last second took three separate bills, the administration bill, a Republican bill, and a Medical Association bill, put them all together, and made Medicare part A, Medicare part B, which pays doctors, and Medicaid. But now we just discovered some tapes recently released that show Lyndon Johnson was in on it right from the start. He would call Mills over and over again, and say, Wilbur I need Medicare. And Wilbur Mills would say, I can't pass that, I've been fighting it all my life. And Johnson would say, Wilbur, you'll get all the credit. Wilbur, say it wasn't big enough, make it bigger. And he worked and worked and worked, and even suggested the contours of Wilbur Mills' great coup.

Ryssdal: Jump with me from Lyndon Johnson to the Clinton administration. We all know the story of that -- '93, '94 -- it doesn't really work because Clinton was so in the details. What was about that entire episode that made it not go so well.

MORONE: First, one lesson, Johnson understood this, is speed, you have to move very quickly. And the Clintons moved very slowly. He also split his own coalition. NAFTA, which was a free-trade agreement, completely demobilized his supporters. But the great lesson from Bill Clinton: learn to lose. Clinton walked away. He was so eloquent about passing national health insurance. Once he lost, what does he say in his memoirs? I felt bad for Hillary. The result is that the spin about what happened was made by the opponents of the program. And national health insurance, indeed health reform, completely disappeared from the public discussion, as incidentally did the Democratic majorities.

Ryssdal: Roll up all of this 75 years of history for me, though. If President Obama calls you tomorrow, and says, listen Jim, I'm in a little bit of trouble here, what do I do? What do you tell him?

MORONE: Hush your inner economist. There's one scene from this play that goes in every administration. People walk into the Oval Office and say we can't afford this. The universal lesson of health reform is benefits first, cost control second. And learn how to lose if you have to lose, continue the good fight, create a movement, work with Congress.

Ryssdal: Aren't we in a position now, though, where we can't not worry about costs?

MORONE: Of course, we have to worry about costs. But if the debate becomes essentially a debate about costs, it just becomes too hard to get through Congress. What Obama has got to do, and I think this has been true for every successful health-care reform, what Obama got to do is remind people of all the pain the health-insurance system is causing them, and keep that front and center.

Ryssdal: James Morone chairs the political science department at Brown University. He is the author of the new book, with David Blumenthal, called "The Heart of Power." Professor, thanks a lot for your time.

MORONE: Thanks, Kai, that was great fun.