If Franklin Delano Roosevelt, president of the United States through the Great Depression and World War II—if FDR, that canny old political operator, that shrewd judger of men, that merry spinner (“First thing we do is deny we were in Philadelphia!”) that cold calculator (he put Joe Kennedy to head the first Securities and Exchange Commission, setting the fox among the foxes), that patient and knowing waiter-outer of events—if FDR were advising President Obama right now, what would he say?
He might look at the lay of the land and tell Mr. Obama something like this:
“My friend, you’re in a bit of a fix. Falling polls, decreasing support for health care. Beyond that, you’re stuck in a bit of a lose-lose. If you don’t get a bill along the lines you’ve announced, you’ll look ineffective and weak—a loser. If, on the other hand, you win, if you get what you asked for, it will all be a mess and all be on you. The system will be overwhelmed, the government won’t be able to execute properly, the costs will be huge. The new regime will thoroughly discombobulate things just in time for everyone’s complaints to reach a crescendo by Election Day 2010.
“But I have an idea, and hear me out. You already have Medicare, a single-payer national health-care system for those 65 and older. Little Harry Truman was the first American to get a Medicare card in 1965, did you know that? LBJ hauled him in for a ceremony. Anyway, Americans like Medicare. So here’s the plan. From here on in, every day, start talking about it: ‘Medicare this, Medicare that, Medicare.’ Get your people in Congress to focus on making the system ‘healthier.’ It’s rife with waste, fraud and abuse, everyone knows that. And there’s the demographic time bomb. Come together in a great show of bipartisan feeling with our Republican friends and announce some serious cost-saving measures that are both legitimate and farsighted. Be Dr. Save the System. On thorny issues like end-of-life care, put together a bipartisan commission, show you’re open to Republican suggestions.
“Then, at the end, get your Democratic majorities to make one little change in the program—it’s now open to all. You don’t have to be 65. The uninsured can enroll. Do it in the dead of night if you have to, you’ve got the votes.
“And then, and only because you’ve all made so many institutional and structural changes, you’ll have to give Medicare a new name. I’d suggest ‘The National Health Service.’
“Voilà! You now have the single-payer system you wanted.
“Everybody wins. You get expansion, Republicans get cost control, the system is made more secure, and the public for once isn’t terrified.
“Republicans of course will say they won—they defeated a brand new boondoggle nationalized health system. Fine. But people will start referring to the National Health Service every day, and they’ll believe they have one, and they’ll believe you gave it to them. And you can run in ’12 saying you did. That’s what I’d do!”
Before departing in a cloud of cigarette smoke and martini fumes, FDR just might add, “A second option, though lacking that special spark of deviousness, is the Wyden-Bennett bill. it’s cost-neutral, it’s not single-payer, but everyone gets coverage. And that was the point, wasn’t it? You can brag about health care for all and fiscal prudence. Not bad!”
* * *
If Richard Nixon—one of the great vote counters, a man who loved policy more than politics but was very good at the latter until he wasn’t anymore, a man who acted so very tough because his heart had been broken, not only by Watergate but by other things (he was right about Alger Hiss and still they wouldn’t honor him; he gave liberals everything in terms of domestic programs and still they wouldn’t love him)—if he met in Washington with the national Republicans of 2009, he might, just might, say something like this:
“Men, and a few ladies, and it’s wonderful to have you here, you’re in a good position and a bad one. Good: The American people are peeling off from nationalized medicine or socialized medicine or whatever you call it. Bad: I’m not sure the peeling off has anything to do with you. There’s something going on that I never foresaw, and it’s the fact that you don’t seem anymore to be the face of the party or of the movements within it. People with TV and radio shows do. Media people! There’s a plus to this but a minus, too. They’re sucking all the oxygen out of the room. You think they’re supporting you, but they’re really supplanting you! You’ve got to figure out how to come to the fore more and break through. But that’s small beer. Big thing is the current debate.
“You still haven’t given the American people coherent alternatives and arguments, or not so the people have noticed. You’ve got to have a strategy, and you’ve got to be serious. Put all internal jockeying aside and remember your philosophy, the thing that made you be a Republican and not a Dem.
“They’re calling you all Dr. No, but that’s not really taking off, so don’t worry about it. But they are tagging you as guys who think this is all just about politics. Remember, the majority of the American people don’t care at all about your political prospects. Why should they? Unlike everyone in Washington and the media, they’re not political obsessives. They actually have lives. They care about what happens to them when they’re sick. So stop the ‘Obama’s Waterloo’ stuff—what a mistake that was, to make yourselves look cynical and purely partisan!—and refocus. Come back to first principles and prudent warnings, but always within a context of clear patriotism. At the end of the day, America needs a successful president. It’s dangerous to have a wounded duck six months into a presidency in a dangerous world. So help him by gently instructing him. He’ll hate that, because in his mind he’s the teacher and you’re the student. Point out that there’s a lot the president doesn’t understand, come forward every day with your ideas, talk them up, get them out there.
“For instance: As you know, doctors keep fees up and order expensive tests because they’re afraid of malpractice suits. They pay terrible insurance premiums. We have to reform that. Stop calling it ‘tort reform’; normal people think a tort is something you eat for dessert. Call it the Limiting Lawyers’ Windfalls bill. No one likes lawyers anymore, Perry Mason’s dead. And make it real when you talk. Here you can pinpoints an Obama weakness that you’re not even exploiting. He won’t go near legal reform because his biggest backers and contributors are the trial lawyer’s lobby. He talks about the common good—give me a break. As Jack Kennedy used to say, and so eloquently, here you can really stick it to him and break it off.
“And speaking of JFK, try to seize back a bit of the issue of health in general. Remember physical fitness and vigor and 50 mile hikes on the C&O Canal? Completely captured the public imagination. JFK himself didn’t do it, he wasn’t insane, and he had the bad back. He sent Bobby and that fat Pierre Salinger. Anyway, go with that: personal responsibility, strength, health. Steal it from the Dems. But don’t imitate their censorious tone: ‘Ya can’t smoke, put down that doughnut.’ Let me tell you, doughnut eaters are the largest growing demographic in America. Don’t get crossways with them!”