The Heart of Power: Health and Politics in the Oval Office

by David Blumenthal, James A. Morone

Even the most powerful men in the world are human—they get sick, take dubious drugs, drink too much, contemplate suicide, fret about ailing parents, and bury people they love. Young Richard Nixon watched two brothers die of tuberculosis, even while doctors monitored a suspicious shadow on his own lungs. John Kennedy received last rites four times as an adult, and Lyndon Johnson suffered a "belly buster" of a heart attack. David Blumenthal and James A. Morone explore how modern presidents have wrestled with their own mortality—and how they have taken this most human experience to heart as they faced the difficult politics of health care. Drawing on a trove of newly released White House tapes, on extensive interviews with White House staff, and on dramatic archival material that has only recently come to light, The Heart of Power explores the hidden ways in which presidents shape our destinies through their own experiences. Taking a close look at Franklin D. Roosevelt, Harry S. Truman, Dwight Eisenhower, John Kennedy, Lyndon B. Johnson, Richard Nixon, Jimmy Carter, Ronald Reagan, George Herbert Walker Bush, Bill Clinton, and George W. Bush, the book shows what history can teach us as we confront the health care challenges of the twenty-first century.

Genres: History, Nonfiction, Politics, American History, Health Care, Health, Public Policy

494 pages, Hardcover

First published January 1, 2009

Reviews

[John · Rating 5 out of 5]

Fascinating read on the history of health reform and the role of each president since FDR

[Gordon Kwok · Rating 4 out of 5]

I was torn between giving this book 4 stars and 5 stars...I actually wanted to give the book a 4.5 stars. Overall, it's a book about the presidency from Truman to Bush 43 and how they ranked in terms of passing health care coverage/legislation. My biggest gripe with this book and I really hope the authors consider it if there is a reprint is that the president who they considered the "greatest" (out of 11 presidencies examined) healthcare president (LBJ) was not on the cover. That does not make sense at all.

Instead, the authors placed Clinton, FDR, Reagan and Eisenhower on the covers. The authors considered Clinton a talent politician but judged him as a bad healthcare president because he didn't follow some of their basic rules (e.g., speed, vision, don't get into the details leave that to staff) but if you thought he was so terrible, why would you put him on the cover?? FDR is considered by the authors and almost all credible historians in the upper echelon of presidents (i.e., Lincoln, Washington and FDR are top 3 of all time) but they kept on saying FDR literally showed no interest in getting healthcare passed for valid reasons...WWII, Great Depression and blocked by the Southern Bulls who held almost all the important committee chair seats. Same logic as before, if you think FDR wasn't a great healthcare president, why is he on the cover of a book about healthcare presidents...?? Reagan was another president that the authors considered ultimately butchered healthcare by proposing cuts and he was somehow able to pass catastrophic insurance for seniors but that was repealed in his first year of office, what a disaster no pun intended. Lastly, there was Eisenhower...in terms of being a healthcare president, there is a plausible case that he should be on based on how he shaped modern day healthcare with the employer provided health insurance and that on balance, he wasn't a terrible healthcare president but he wasn't an "awesome" one either.

Fun facts...the authors contain a chapter at the very end about general rules that will dictate whether or not your healthcare plan will succeed based on their examination of the different factors and a quick glace at them will tell you why some succeeded (LBJ and ultimately Obama) and some failed or will fail (Carter and Trump). Some of them are things like "passion" meaning that the occupant has to genuinely care about the issue and take political risks on it and "vision" meaning have a grasp of the topic and use the biggest weapon of the office which is the bully pulpit. Here, this will tell you why Trump will ultimately fail in healthcare because he neither understands it (said so himself) or cares about regular people (shows in his contempt for regular people). All in all, a very worthwhile book.

[Austin Barselau · Rating 2 out of 5]

In THE HEART OF POWER, David Blumenthal and James Morone describe how seven decades of presidential administrations grappled with the inescapable issue of health care reform. Blumenthal, an academic physician, and Monroe, a political scientist, survey the presidencies of FDR, George W. Bush, and everyone in between to identify the shortcomings and successes of health care reform, from FDR and Truman’s inability to will about universal coverage, Eisenhower’s creation of federal employee health benefits and the tax exemption for employer-sponsored insurance, LBJ’s lassoing of Medicare reform, Nixon’s promotion of health maintenance organizations, Clinton’s failed campaign for managed care, and Bush’s popular Medicare prescription drug program. Through all these presidencies, the authors identify several keys to winning large-scale reforms, including cultivating a cabinet of experts, capitalizing on political momentum, commanding the bully pulpit, sharing credit, and muzzling the economists. The authors also aim to draw a connection between the personal health stories of each president and their stance on health care reform, arguing that “each president has a health story.”

Ultimately, this book falls short of a sweeping history of health care reform. Blumenthal and Monroe are quick to typecast certain health care presidencies as either successes (Eisenhower, LBJ, Nixon, Reagan, Bush) or failures (FDR, Truman, Kennedy, Carter, Clinton), but the realities are far more complex. The authors overweigh the power of the presidency in the landscape of health care reform and underweight the influence of congressional actors and committees in mobilizing for action, and the competing priorities on the presidential agenda that trim the sails for health reform. The authors are quick to ascribe credit for reform to certain presidencies when the source of such reforms was Congress (such as in the Eisenhower and Reagan administrations, both of which were indifferent or opposed to widescale reform). The authors also attempt to link the personal affliction of each president with their motivations for health care policymaking – in many cases, they fail to successfully connect those stories with policy activism. The book covers far too large of a period of history to sufficiently weigh these intricacies and tradeoffs, while also including too much irrelevant biographical information that detracts from the cohesiveness of the narrative. Ultimately this book is a shallow and misguided history that fails to meet its potential.

[Brian · Rating 2 out of 5]

An interesting approach to dealing with health care policy through the stories of different POTUSes. The most compelling stories I found where FDR, HST, and LBJ—all Democrats who wanted universal health care for all Americans and who all came up short. FDR never got far with it, and it is not clear to the authors why it was not made a higher priority. They offer several explanations but there was no single definitive reason. HST tried the hardest but was sabotaged by members of his own party who blocked his efforts in committee. LBJ got the most--one could say two-thirds of a loaf--but his compromises made expansion to a system of universal health care difficult and created a program that was much more expensive than a single-payer policy.

The Republicans all come off as two-dimensional and their stories are far less interesting, with the possible exception of Nixon. In Nixon's case, he was complex but impenetrable to the authors. I was disappointed that there was no chapter on Ford and he was mentioned only in passing as a Congressman.

The story ends on the eve of the Obama administration, the stage set for the Affordable Care Act, or "Obamacare." In many places, the book seems like a rush job to give the back story to Obamacare. It is repetitive and suffers from distracting editorial lapses. It reads like a series of sophomore history class term papers rather than a work by two distinguished professors. Given the authors' reputations, I expected much better.

[James Wilcox · Rating 4 out of 5]

Good look at how 11 administrations have tried to deal with the health care issue starting with FDR and ending with George W. Bush. The author tries desperately to provide balance, non-partisan treatment for each administration, which is good, but man this really read like a textbook. It certainly dragged on longer then it needed to.

[Leah Pridemore · Rating 5 out of 5]

I had to read this for grad school, but enjoyed it right from the beginning.

[Jim · Rating 2 out of 5]

a narrative history of 20th century presidential health care politics. each presidency from fdr to w is treated separately. as a simple statement of fact, it is an interesting account which illustrates the complex interests which intersect in health care reform and the countless reasons various reform attempts have failed.

i found three features frustrating. first, the authors try entirely too hard to tell the story in a non-partisan fashion, which basically means splitting the difference on partisan judgements. for every negative statement about george h. w. bush, there is an equal and and opposite negative statement about jimmy carter. this form of "balance" is both intellectually dissatisfying and detrimental to the narrative. my second critique stems from the authors' tendency to offer brief presidential biographies, infer the president's psychological state from those biographies and then use that information to understand their policy approach. while, i'm dubious about historical reconstruction of psychology in general, such reconstructions are particularly unpersuasive when the treatments are so brief and overly simplistic. finally, the authors hammer home their themes for why health care policy succeeds and fails in every single chapter. while some of these themes have merit, the reader is frequently subjugated to being beaten over the head with rather tortured explanations of how a given president fit into each and every one of those themes.

[Dan · Rating 3 out of 5]

This book is the text of a continuing ed class I am taking. It discusses how each of the US Presidents from FDR through George W. Bush dealt with the issue of health care. It draws some conclusions about what a President should do if he hopes to get passage of health care reform.

Among the things I learned from this book: First, I like Ike. He said, "In all things which deal with people be liberal, be human. In all those which deal with the people's money or their economy, or their form of government, be conservative." Second, although expansion of health care is usually the platform of the Democratic party, between FDR and President Obama it has actually been Republican Presidents, Reagan and George W. Bush, who drove the largest expansions of health care coverage. Third, the politics we witnessed during President Obama's push for health care reform were really nothing new; "tricks" used on both side of the aisle have been used before when dealing with health care reform by both parties. Fifth, President Obama either read this book or came to the same conclusions independently; he seems to have learned from history what it takes to get health care reform passed because he followed most of the lessons-learned in this book.

[Nanette Bulebosh · Rating 4 out of 5]

I loved this book! The authors examine how the last century's presidents, starting with FDR, dealt with the health care issue. FDR intended to initiate universal health care, as a kind of follow-up to Social Security, but he was dissuaded by his doctor friends. Nixon, surprisingly, looked at the issue with a great deal of compassion, having watched two brothers die of TB. Johnson comes off as a great progressive hero, with his ability to twist elbows behind the scenes and his willingness to give even political opponents credit for success in order to achieve his ends.. The real standout, though, is Truman, who considered a national health care plan his most important work. He was frustrated by his failure to pass meaningful legislation. This is why it was so moving when LBJ made sure to include the former president when he signed the Medicare bill in the 1960s.

I also recommend listening to the several authors' interviews on the web. I heard co-author James Morone, a professor at Brown University, on public radio and he was fantastic. Google him, listen to him talking about this book, and you'll want to read this book too.

[Joel · Rating 5 out of 5]

I've always been interested in the Presidency and the things that shape presidents' policy and politics. This book combines the personal, policy, politics, and historical accidents that shape one of the most difficult public policy issues any president has to face. Great history and great views of the people in the office. Well written (some parts read like a novel). And great advice for any president seriously working the issue and the politics: passion necessary, big picture (not details) key for president, handle (squash) the economists, go public, be prepared early (before the transition), prepare for setbacks and losses, handle congress (the most complex legislative body in the world with built in reasons not to change), and prepare the next president.

[Holly Foley (Procida) · Rating 5 out of 5]

I read a fair amount of Non-fiction and have read some great biographies of 20th century presidents. Good books by Clark Clifford and Arthur Schlesinger come to mind to give perspective through several presidencies. But this is the best book I have read on 20th century presidents yet!

It gives great perspective of the health care issue, which is to say that NO ONE can understand and solve it. It gives very meaningful biographical information and great information on each pres. leadership style and the political climate of their time.

Definitely worth a read, especially if you feel that your history education never took you much into the 20th century.

[Henry Perretta · Rating 4 out of 5]

More interesting than I thought it would be --- covers "Reform" as a presidential agenda item from Teddy Roosevelt thru George W Bush. LBJ is off the charts star; Jimmy Carter a disaster. Ronald Reagan: not what you thiink (a good deal more liberal). Nixon would have gotten historic achievement but was sidetracked by this little adventure called Watergate... Anyway - we've been like a broken record on this in Congress for almost 100 years...

[Martha · Rating 3 out of 5]

I thought this was an interesting idea - a book that looked at how the connection between the specific health issues of presidents and their family members, and the philosophy of family doctors they knew, influenced the oval office approach to health care policy.

[Erin · Rating 4 out of 5]

Interesting insights, you just need to get past the many typos the book contains.

[Sheetal · Rating 4 out of 5]

very thorough history of health and politics, very informative for the history buff.

[B · Rating 3 out of 5]

Good, but not great. Useful as a capsule summary. Analysis seems weak and there's a lot of trouble with proper nouns throughout.

[Melissa · Rating 5 out of 5]

I was assigned book for a health policy fellowship. Great read and gives insight into the whys and how's of the politics of health care

[Maggie Galbraith · Rating 5 out of 5]

I expected this book to be quite dull, but it was just the opposite. I actually learned quite a lot. Extremely interesting.