1. © 2008 Delmar Cengage Learning. Chapter 5 The Presidency David Blumenthal and James Morone

2. © 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

3. © 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

4. © 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

5. © 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

6. © 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

7. © 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

8. © 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

9. © 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

10. © 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

11. © 2008 Delmar Cengage Learning. 11 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

12. © 2008 Delmar Cengage Learning. 12 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

13. © 2008 Delmar Cengage Learning. 13 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

14. © 2008 Delmar Cengage Learning. 14 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

15. © 2008 Delmar Cengage Learning. 15 Chapter 5 Summary The presidents from FDR forward have each had a unique impact on the direction of health policy