What would LBJ do to pass health care reform?

[ehrnst]

Since Bernie Sanders invoked LBJ's passage of Medicare and Medicaid in his OpEd, lets take a closer look at LBJ.

One of his aides put together this list in 2009, when the ACA was being developed:

He would have a willingness to horse-trade with every member.

He would keep a list of people who support each member financially. A call to each to tell them to get the vote of that representative.

He would have Billy Graham calling Baptists, Cardinal Cushing calling Catholics, Dr. Martin Luther King calling blacks, Henry Gonzales calling Hispanics, Henry Ford and David Rockefeller calling Republicans.

He would get Jack Valenti to call the Pope if it would help.

He would have speeches written for members for the Congressional Record and hometown newspapers.

He would use up White House liquor having nightcaps with the leaders and key members of BOTH parties.

Each of them would take home cufflinks, watches, signed photos, and perhaps even a pledge to come raise money for their next election.

http://www.cnn.com/2009/POLITICS/08/24/johnson.lbj.health.care/index.html

Note - he worked with people - he didn't alienate those who disagreed with him. He didn't just dismiss anyone who wasn't on board, or had questions as corrupt. He didn't assume people were not on board with the plan "hated him."

He got it done because "compromise" wasn't a dirty word to him.



He did, however lie about what it would cost, because he knew it wouldn't pass if he was upfront about it. That can't be done today, now that we have the CBO.

Johnson maneuvered every step of the way getting this bill through Congress, and one of the things he did — and this is a little dicey in today's climate — was suppress the costs. So this young kid gets elected from Massachusetts, Ted Kennedy, in 1962, and Johnson is explaining to him [over the phone] how you get a health bill through. And what he tells him is don't let them get the costs projected too far out because it will scare other people:

"A health program yesterday runs $300 million, but the fools had to go to projecting it down the road five or six years, and when you project it the first year, it runs $900 million. Now I don't know whether I would approve $900 million second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in saying, 'My God, you've got a billion-dollar program for next year on health, therefore I'm against any of it now.' Do you follow me?"

We believe, after looking at the evidence, my co-author [David Blumenthal] and I, that if the true cost of Medicare had been known — if Johnson hadn't basically hidden them — the program would never have passed. America's second-most beloved program would never have happened, if we had had genuine cost estimates.

http://www.npr.org/templates/story/story.php?storyId=112234240

[Madam45for2923]

1. So interesting!

[Arkansas Granny]

2. There's a lot that can be said about Johnson, some good, some bad, but he knew how Congress worked

and he knew how to work Congress. He was a skilled politician and despite his handling (or mishandling) of the Vietnam war, I believe he had the best interests of the American people at heart.

[Orsino]

4. If only Congress still worked like that.

Political skill has turned out to be nearly irrelevant in the face of donor gigabucks and lying corporate media.

Hell, we could probably have Medicare-For-All on the moon if it were just a matter of negotiation.

[ehrnst]

6. Actually, it's a matter of costs. He had to lie about it

in order for it to get passed.

Are you saying that money wasn't in politics in LBJ's day? That because the donors then don't have the dollars now, that there wasn't as much influence?

Seriously?

Looks like conservatives aren't the only ones with rose colored glasses about "the good old days."

https://www.washingtonpost.com/opinions/how-political-donations-changed-history/2012/01/16/gIQA6oH63P_story.html?utm_term=.5f4fe8b0f3f1

You may be interested to learn that the AMA was fighting him on it, and they had the $$$$.

https://www.newyorker.com/news/news-desk/medicare-made

[Orsino]

8. No, it's really not a matter of costs.

Or the US$700 billion proposed for the Pentagon might have raised more eyebrows.

[ehrnst]

9. Um... Yes, Medicare and Medicaid would not have been passed if he had not lied about the costs.

And the $700 Billion proposed for the Pentagon is a different issue. Also, I don't think that there is any plan to upend the way that the military is run and funded in four years on the table. Is there?

And moving funding from the Pentagon isn't one of the funding mechanisms in Sanders M4A plan, if I recall.

Whataboutism doesn't make any more sense in policy discussions than it does when DT starts in with "what about Hillary???"

[Orsino]

10. Sure. But the OP asked how Zombie LBJ would pass healthcare reform *now*.

Cost is more than ever just an excuse trotted out to neg anything a Republican doesn't want. That disease certainly has affected Democrats, too, who have been known to low-ball reforms we want to see.

Cost may be a factor nowadays, but far more important things have to change before we ever get a loyal opposition willing to address budgeting honestly. We'll know we're getting closer when Pentagon billions have to be fought for with anything like the grass-roots fervor we've mustered on healthcare.

[ehrnst]

14. No, actually how zombie LBJ would pass health reform in 2009.

Which actually did get passed, if you recall. And the ACA wasn't like what "Medicare for All" is now, in terms of scope, timeline or costs.

Cost is not an excuse - it IS a factor, not just "may be."

A low CBO score can destroy the chances for a piece of new legislation.

It is also much harder to bring costs down for a current entity - like the Pentagon, than it is to kill spending for something new. The Pentagon is an established part of the budget, and as such has many, many contracts in place. I'm not saying that's good - I'm saying that's why you can't really compare the willingness to continue funding established entities with willingness to fund something new - especially if it involves upending 14% of the GDP in the space of only four years.

Just like the economic reality that it's much harder to bring down health care costs than it is to keep them down from a low starting place, like they were in Europe in the 1940's.

[Orsino]

17. We *know* that cost is an excuse as well as a factor.

When it's the Pentagon, though, it's damned near neither. When it's healthcare, we can count on its being an excuse, and a factor on those rare occasions when someone honestly discusses real numbers.

[ehrnst]

18. A low CBO score is not an "excuse"

You are unhappy that the Pentagon gets the money it does. I understand that.

That does not excuse dismissing costs in a health care reform bill. The CBO has a big part in whether any such bill will get support.

CBO’s cost estimates show how new legislation would affect three primary components of the federal budget (see the graphic):

Discretionary spending—that is, spending stemming from authority provided in annual appropriation acts;

Mandatory, or direct spending—that is, spending controlled by laws other than appropriation acts; and

Federal revenues—effects on federal tax receipts and revenues from other sources (as estimated by the staff of the Joint Committee on Taxation for most tax legislation or by CBO for legislation dealing with certain sources of revenue, such as receipts from customs duties, fees, and fines).

https://www.cbo.gov/about/products/ce-faq

Analysts from a liberal health care think tank who went deep into Sanders 2016 bill found that it was going to need higher taxes than what he claimed, and it would have a far greater disruptive impact on health care delivery than a plan that was implemented over a longer period of time. I understand that Sanders has added co-pays to the new plan, but hasn't changed the time frame of four years.

https://www.urban.org/sites/default/files/publication/80486/200785-The-Sanders-Single-Payer-Health-Care-Plan.pdf

And the estimates of the taxes needed to pay for Green Mountain Care were part of what scuttled it in Vermont.

http://www.nejm.org/doi/full/10.1056/NEJMp1501050

[Orsino]

25. You're talking honest numbers.

Those should never be just an excuse, as you say. We are dealing with Republicans, though, who will cherry-pick numbers. A big, bad CBO score on cost could certainly be an excuse for a GOPer who is dishonest about what we're getting for our money to refuse to discuss a bill further.

As usual, you and I are splitting different hairs. When I say that cost isn't a factor for a Republican, I'm referring to ostensible negotiation with that party and in the media in order to gain support or compromise on a bill we want. When you insist that cost is a factor, and should be, I don't disagree with you--when it comes to the real impact of a prospective law, we on the Dem side need to be the grown-ups who are relatively straight with voters about cost/benefit, and we need to make good deals when the numbers don't add up.

[ehrnst]

27. Are you saying that the CBO would not be honest?

The bad CBO score on the first GOP attempt at repeal was a big reason that it failed. Which is why they were so anxious to get Graham Cassidy through before they could score it.

We can't cherry pick when the CBO score matters and when it doesn't.

[Orsino]

31. Not at all. CBO has some of the best data and analysis.

But I don't agree that the CBO score was a big factor in the latest repeal kabuki. We never even got the full score before it was dead. I think what killed it was mostly citizen outrage and a lack of GOP commitment to owning a full repeal.

[ehrnst]

32. I was talking about the first repeal attempt

http://www.businessinsider.com/cbo-score-gop-obamacare-repeal-bill-2017-7

Which is why they were desperate to get Graham-Cassidy through before they could score it.

Again - if we live by the CBO scoring for them, we have to live by it for our own bills.

[Orsino]

35. Oh. Even there I would disagree that the CBO was a big factor.

I believe that the myths about death panels have mostly faded from public memory, and a clear majority are ready to bend the ears of their representatives to preserve ACA. I don't think the GOP wanted to repeal it, but seven years of grandstanding meant that they had to pretend to try, right up to the last month. Any such game of chicken is dangerous in itself, and it has hurt them for 2018, but they don't seem to have been serious.

They'll still want to damage Obamacare, no doubt, but they'll do it more subtly.

[ehrnst]

36. The CBO score was the main talking point in the media...

https://www.cbsnews.com/news/cbo-score-on-latest-senate-gop-health-care-bill/

https://www.nbcnews.com/politics/congress/cbo-17-million-fewer-insured-under-republican-obamacare-repeal-n784606

https://www.vox.com/2017/7/19/16000840/senate-obamacare-cbo-score

http://www.businessinsider.com/cbo-score-gop-obamacare-repeal-bill-2017-7

http://abcnews.go.com/Politics/cbo-estimates-32-million-uninsured-decade-obamacare-repeal/story?id=48732539

https://www.washingtonpost.com/news/politics/wp/2017/07/25/whatever-the-senate-votes-on-the-trade-off-republicans-are-making-has-been-consistent/?utm_term=.3edaea374d58

http://www.politico.com/story/2017/06/26/gop-senate-health-care-bill-cbo-score-239921

http://fortune.com/2017/07/26/health-care-vote-obamacare-repeal-fails/

Whereas the ACA got a good CBO score, and the revised CBO score is better:

https://www.washingtonpost.com/news/wonk/wp/2017/06/26/heres-how-well-the-cbo-did-at-forecasting-the-last-big-health-care-bill/?utm_term=.642c2c33b6c8

https://www.cbo.gov/publication/52486?utm_source=feedblitz&utm_medium=FeedBlitzEmail&utm_content=812526&utm_campaign=Express_2017-03-13_16%3a30

[Orsino]

48. Yes. I just doubt it was a big deal.

Anyone looking at the bill knew it was a repeal, and that's even how Republicans talked about it. They hid from constituents who were rightly terrified of losing coverage.

The CBO report certainly supported their fears, but I think Americans actually paid attention on this issue.

I hope this doesn't come across as me attempting to diminish the importance of the CBO, but I think the public in this case was all omg without much need for their bottom line.

[ehrnst]

51. What do you define as "a big deal" in terms of taking a bill

and why is a CBO score not high on that list? Because that does come across as diminishing the importance of the information that the CBO released - such as the number of Americans who would be left uninsured, how much more seniors were going to have to pay in premiums, etc.

What data do you have that "Americans actually paid little attention on this issue?" - because it was all over social media.

[Orsino]

64. I have no data suggesting that it was the CBO score, or reporting on it...

...that drove Americans in unprecendented numbers to harangue their reps at town halls (the ones that weren't canceled).

Yeah, it was reported, but so was the existence of the bill itself.

[ehrnst]

66. You said that you thought that people weren't paying attention to the CBO numbers

of people who would lose health care by 2020, despite the fact that they were all over the news and social media.

I asked why you thought that. At least that is what you said.

Are you going to answer?

[Orsino]

67. I think the news covered the basic facts pretty well...

...and when the bill is so clearly a repeal of so many people's healthcare, the details of the CBO report were relatively unimportant.

[ehrnst]

68. So "unimportant" that theCBO number of uninsured by 2020 were included in the headlines?

https://www.cbsnews.com/news/cbo-score-on-latest-senate-gop-health-care-bill/

https://www.nbcnews.com/politics/congress/cbo-17-million-fewer-insured-under-republican-obamacare-repeal-n784606

https://www.vox.com/2017/7/19/16000840/senate-obamacare-cbo-score

http://www.businessinsider.com/cbo-score-gop-obamacare-repeal-bill-2017-7

http://abcnews.go.com/Politics/cbo-estimates-32-million-uninsured-decade-obamacare-repeal/story?id=48732539

https://www.washingtonpost.com/news/politics/wp/2017/07/25/whatever-the-senate-votes-on-the-trade-off-republicans-are-making-has-been-consistent/?utm_term=.3edaea374d58

http://www.politico.com/story/2017/06/26/gop-senate-health-care-bill-cbo-score-239921

http://fortune.com/2017/07/26/health-care-vote-obamacare-repeal-fails/

[Orsino]

69. Yep. n/t

[George II]

12. In the case of Johnson, I think it was more a matter of hiding the truth than outright lying.

Throw in a little bit of exaggeration. But the thing about Johnson is that he got things done. Imagine what he/we could have accomplished if we weren't mired down in the Vietnam War?

For one thing, he would have run for a second term and won, so we wouldn't have had the years of ineffectual leadership under Nixon/Ford once the Watergate burglary occurred.

[ehrnst]

15. "Supressing the costs" I think counts as a lie.

Last edited Wed Sep 27, 2017, 11:12 AM - Edit history (1)

When Reagan suppressed C. Everett Koops' findings on the study of so-called "post abortion stress syndrome" - that it didn't really exist, I would call it lying.

In any case - there is no 'hiding' the costs and ramifications of any health reform act now.

[Hortensis]

47. "He got things done." Exactly. He was a tremendous big thinker and doer.

In particular, Johnson knew virtually everything there was about how to use the many tools of government and created a number of them himself. Nice that Sanders invokes Johnson's victories, but he would have done well decades ago to study how Johnson accomplished them. Who knows, if his antipathy toward the growing concentration of wealth among a few had been combined with Johnson's know-how, perhaps he could have made a difference.

Johnson's actually my favorite president perversely because of both his greatnesses and his great and many flaws. I went to see him speak when I was a little girl. For me the dreadful tragedies for our nation of Vietnam absolutely include the derailment of Johnson's presidency in his first full term. What else WOULD he have accomplished then and in the next term that never was? He'd been against national healthcare as a senator, but not as a president. And I'm remembering that Johnson notified congress that climate change was real and they needed to start acting in 1965. He'd have fought the Kochs and their type, and my money would have been on him.

The nation's progressive mood lasted to the end of the 1970s. What else would he have accomplished with that wind still at his back?

If only.

[Voltaire2]

60. He had functional majorities in both houses

that was where he started from.

[greatauntoftriplets]

3. He also knew what skeletons were in various congressional closets.

And wasn't afraid to use them. LBJ spent his years in the Senate and as VP schmoozing his colleagues on Capitol Hill and how to sway them. His gregarious personality was a formidable tool.

It's just too damn bad that Vietnam was his downfall. No one could have solved that morass, in much the same way that we're seeing today in Afghanistan and Iraq. He was otherwise a truly great president.

[ehrnst]

11. One would have to have known those other politicians to know what skeletons there were

One would have to make friends, alliances, and work in a team, over the course of years.

I am old enough to recall a lady candidate being accused of "creating contacts inside the beltway and therefore having an unfair advantage" for doing just that.

So I doubt that kind of power will be available to the M4A campaign now.

[greatauntoftriplets]

13. Sigh, that kind of power should be available.

LBJ was a master legislator, probably second to none in my lifetime so far.

[ehrnst]

20. It requires relationship building, not simply yelling and dominating the conversation.

Yes, he did some of that, but he also built alliances, instead of telling others they were unethical if they disagreed with him, listened deeply instead of insisting that he was the smartest person in the room. He got the deep respect of the people that he worked with, and not just cheering crowds of people that didn't work with him.

We had that in HRC, and she was pilloried for it.

[greatauntoftriplets]

40. LBJ worked hard to build consensus.

When that didn't work, he'd comprise. Nor was he above twisting a few arms when necessary. It worked, or else we wouldn't have now have some landmark laws -- Medicare and the Civil Rights Act -- or might still be arguing about them.

[JHan]

50. "one would have to make friends, alliances and work in a team".

Yes,, and one would not hang "establishment" around the necks of allies like an albatross.

[NastyRiffraff]

5. Johnson was a master at compromise

Some call it wheeling and dealing, some would probably call it "giving in" or being wishy-washy. But Johnson was far from wishy-washy, and he fought hard for what he wanted. He was more than willing to compromise; in fact he considered that a vital part of the political process.

[ehrnst]

7. Politicians who show distain of actual politic-ing aren't usually very effective at the job.

Our current DOTUS is but one example I can think of.

[NurseJackie]

16. Yes. Compromise and finding common ground is key. For the life of me, I'll NEVER understand...

... why it is that there are SOME people who believe that it's a "positive" thing to LOSE GROUND and to GO BACKWARD due to an unwillingness to find common ground.

That's the exact opposite of what "progressive" means, right?

I can only shake my head in disbelief at those who seem so PROUD of themselves for never giving an inch. People are still as bad-off (or worse) than before, yet some vanity-driven political types bask in the praise and approval. They believe that the status-quo is a victory.

#Sigh
#Sad
#Stubborn
#Vanity

[ehrnst]

19. Taking the "progress" out of "progressive" doesn't

do Democrats, or anyone else any good.

[jalan48]

21. Do you mean when he was Majority leader of the Senate?

As Majority leader of a Democratically controlled Senate he had more power and opportunity to get things done. Sanders not only doesn't hold such a position he is also dealing with a Party in the minority.

[ehrnst]

23. No, he passed it when he was president, and this was written in 2009

more as a suggestion to Obama.


However, since Sanders invokedup LBJ's passing of Medicare and Medicaid when laying out the case that it's now time again, it seemed pertinent to remind of just what LBJ did to get them passed, and what lessons his own aides thought were pertinent to a later health care reform push.

No, Sanders can't suppress the costs like LBJ did. The CBO prevents that.

He can, however work with people, and utilize people skills like LBJ (and Obama) did.

LBJ and Obama spent their time in the Senate building alliances, not alienating colleagues by telling the public that those who disagreed with their legislation were ethically suspect.

[jalan48]

24. Sounds like Sanders needs to get elected President and use that power to get things done.

Works for me!

[ehrnst]

26. Perhaps if he was more like LBJ and Obama, he would be successful at that. (nt)

[jalan48]

28. We shall see. No word from him on 2020 yet.

[ehrnst]

29. You think he will become more like LBJ and/or Obama in the meantime? (nt)

[jalan48]

30. You mean LBJ and Obama when they were in the Senate?

[ehrnst]

33. Yes, and when they ran for POTUS. (nt)

[jalan48]

34. We're back to LBJ being Majority leader of the Senate-a position of power which Sanders does not

hold.

[ehrnst]

37. I was talking about the characteristics that got them respect

and admiration of their peers in the Senate, and got their peers endorsement when they ran for POTUS.

You keep trying to shift the topic away to something else, even though you brought up the possibility of Sanders running in 2020.

Why is that?

[jalan48]

38. Actually you're doing an apples and oranges thing.

[ehrnst]

39. Actually you are...

You brought up the 2020 POTUS run, and I asked if you thought that Sanders would become more like Obama and LBJ when they ran, then you start saying, "he was never Senate leader" and such.

So - do you think that Sanders will acquire more of the traits that Obama and LBJ had that got them elected, and also enabled them to get support for their health care reform, before a second attempt at a nomination?

That's apples to apples, right? People skills. Ones that get you the support and endorsement of your Senate colleagues.

Do you think that he'll acquire more of those prior to running again?

[jalan48]

43. Not really. You're ignoring the power relationships going on in your comparison.

"As a leader in the Senate, Johnson became known for his domineering personality and the "Johnson treatment", his aggressive coercion of powerful politicians to advance legislation. " ---Wikipedia

On the one hand you fault Bernie for not being more like Johnson then ignore the reality of the political set-up in each case. Bernie is not President and doesn't have the power to get things done in the same manner as Johnson did when he was President.

[ehrnst]

44. You are bending over backwards to avoid the question in any way you can think of.

I'm not surprised at all...

[jalan48]

45. LOL-pretzel logic.

[ehrnst]

46. Whatever makes you feel better about avoiding the question...

Sort of like when someone gives up trying to talk sense to someone and, walks away, and the person they were talking to looks around to see who saw it, then yells, "And STAY away, you HEAR me? Or else!"

[GulfCoast66]

55. I would politely suggest that like LBJ

He usher major legislation out of congress first. Or minor legislation for that matter.

LBJ quietly got things done by working within the establishment.

Until a leader of either party decides to do the same we will have gridlock.

[JHan]

56. my take.

there's a real love among some for all things "revolutionary" when it's really the parliamentarians ( the dreaded establishment types) who get things done.

I always question who and what is served by dissing democratically elected representatives en masse by virtue of them being elected to Congress and working the system best they can in less than ideal circumstances - in this case, it's always the self-described populists who benefit politically.

Obama had some populist qualities but he never used divisive tropes pitting allies against each other and causing a push back. It's just unnecessary, especially at this time.

[ehrnst]

57. Hear, hear. (nt)

[Voltaire2]

61. Obama spent all of three years in the Senate.

LBJ, by the way, alienated the racist wing of the Democratic Party as president by getting civil rights legislation passed. That alienation resulted in the collapse of FDR's awful coalition, and the rise of the Republican right. It was a price worth paying, but not exactly the paradigm of coalition building you are claiming. It is perhaps LBJ's greatest legacy, and like all great things, it came with a price.

[ehrnst]

63. To clarify:

He built coalitions among legislators, and non-governmental leaders.

And nothing comes without a price, no matter how just or forward thinking.

[louis-t]

22. Threaten to show us his scar again?

[struggle4progress]

41. He'd lean on em and stare em down

http://sspd.humanitiestexas.org/p.php?a=c31gdXp5JXl0bSc2IjwtPzYzOjE/PSYyKzE8LTI+MiU+JzE/OicjKD8nNyM=&m=1414417372

[ehrnst]

42. LOL! Or threaten to show them his scar...

[JHan]

49. the realities of politics, this is why experience is important..this is how you get shit done.

It's ugly, but somebody's gotta do it.

If I had a dollar for every fancy fairytale bit of revisionist history about the social safety net in America, I'd be as rich as Bill Gates.

[atreides1]

52. Forgot something

LBJ was also known for twisting arms if he had to...and since he seemed to know what skeletons were which closets, he had a lot of leverage!

Sanders isn't even the same league as LBJ!!!

[ehrnst]

53. +1000

[rusty fender]

54. He would increase the bombing

of Vietnam. This hindsight bullshit of declaring that LBJ was such a great president is getting tiresome. He needlessly killed thousands of human beings to avoid being humiliated

[ehrnst]

59. I was referencing Sanders' talking of LBJs achievement of Medicare and Medicaid

And I will say that yes, he accomplished some of the most progressive legislation in our history along with the Vietnam war. To point out the good that Medicare and Medicaid - not to mention the Civil Rights act, and the Voting Rights Act - is not = to saying he was all good. And to point out his efficacy in getting those Great Society institutions in place is a matter of history, not false adulations.

That sort of dualistic, purist thinking will be the death of us, because NO ONE in public life is all demon or saint, because they are human beings.

I'll also give Nixon his due for establishing the EPA. I can do that while also noting that he declared war on Minority populations with the "war on drugs." Because I have the ability to understand that one can praise the actions of someone without making them into a saint.

Especially when they are long-time career politicians.

[WinkyDink]

62. At least LBJ ended up wracked with guilt such that he wouldn't run for re-election.

http://www.nytimes.com/learning/general/onthisday/big/0331.html?mcubz=3

[brer cat]

58. Great post, ehrnst.

Bears repeating:

Note - he worked with people - he didn't alienate those who disagreed with him. He didn't just dismiss anyone who wasn't on board, or had questions as corrupt. He didn't assume people were not on board with the plan "hated him."

[LiberalFighter]

65. Nowadays? Possibly kick a few of them in the balls.

Meet with Trump in Area 51 and let the aliens have him.