© 2008 delmar cengage learning. chapter 5 the presidency david blumenthal and james morone
TRANSCRIPT
© 2008 Delmar Cengage Learning.
Chapter 5
The Presidency
David Blumenthal and James Morone
© 2008 Delmar Cengage Learning.
2
The Limited Presidency
• Presidential power is often curbed by the other governing institutions– Including Congress and the judiciary
• Popular distrust of centralized authority has further limited presidential power
© 2008 Delmar Cengage Learning.
3
The Powerful Presidency
• Crises tend to increase the powers of the president– Particularly in time of war
• Real or figurative
• Powerful personalities and skilled political operators have taken full advantage of the powers left to the president
© 2008 Delmar Cengage Learning.
4
Three Faces of the Presidency: The Individual
• Individual presidents possess the power to place items on the national agenda– To “shape the national conversation”
• Some presidents have entered office with a passion for health reform– Others have been forced to address the issue
© 2008 Delmar Cengage Learning.
5
Three Faces of the Presidency: The Political Operator
• Presidents must become masters of the broader political system if they hope to accomplish their objectives
• Some presidents (particularly Johnson) have proven successful in health policy through their shrewd approaches to handling Congress and other political institutions
© 2008 Delmar Cengage Learning.
6
Three Faces of the Presidency: The Policy Manager
• President must lead an executive branch of 1.8 million employees– Paying particular heed to his cabinet
• “Successful” presidents – Achieve a balance between carefully
considering the advice of policy advisors, and becoming bogged down in details
© 2008 Delmar Cengage Learning.
7
The Presidents and Health Care:Franklin D. Roosevelt (1933-45)
• Universal health insurance initially included among suggested New Deal reforms– Eventually scrapped out of fear that such
“overreach” could jeopardize the broader program of social security
© 2008 Delmar Cengage Learning.
8
The Presidents and Health Care: Harry S. Truman (1945-53)
• Early champion of national health insurance
• Initial health insurance plan foiled by intransigent Congress
© 2008 Delmar Cengage Learning.
9
The Presidents and Health Care: Harry S. Truman (1945-53)
• Despite defeat in first term, Truman presented his plan to Congress during second term– He did not get much further
© 2008 Delmar Cengage Learning.
10
The Presidents and Health Care: Lyndon B. Johnson (1963-69)
• In wake of JFK assassination:– Democrats made huge Congressional gains– Johnson did not need to rely on support
conservative southern Democrats
• Proposals for national health insurance narrowed to plans to provide health coverage to the poor and elderly
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The Presidents and Health Care: Lyndon B. Johnson (1963-69)
• 1965– Medicaid (coverage for the poor) and
Medicare (coverage for the elderly) signed into law
– In the presence of former President Truman
© 2008 Delmar Cengage Learning.
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The Presidents and Health Care:Richard M. Nixon (1969-74)
• Early champion of health maintenance organizations (HMOs)– Signed legislation that encouraged their
(gradual) expansion across the country
© 2008 Delmar Cengage Learning.
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The Presidents and Health Care:Bill Clinton (1993-2001)
• Great latter-day champion of comprehensive health care reform
• Reform plan foundered due to poor Congressional political strategy
© 2008 Delmar Cengage Learning.
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Chapter 5 Summary
• Two aspects of the presidency: – The powerful and the limited
• Three faces key to understanding presidential role in health care policymaking: – The individual, political operator, and policy
manager
© 2008 Delmar Cengage Learning.
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Chapter 5 Summary
• The presidents from FDR forward have each had a unique impact on the direction of health policy