After Health Bill’s Defeat, What Trump Can Learn From L.B.J.

tags: LBJ, health care, Trump, Trumpcare

Michael Beschloss, a presidential historian, is the author of nine books.

Last month, President Trump demonstrated how not to bring a health care bill before Congress. Fifty-two years ago, President Lyndon B. Johnson — a parliamentary wizard with more than three decades of Capitol Hill experience — established a model for how to do it with his landmark program for Medicare.

Mr. Johnson’s law, which amended Franklin D. Roosevelt’s Social SecurityAct, also authorized the federal government to provide states with matching funds for low-income Americans under a plan called MedicaidThat planstarted modestly but now covers more than 70 million people.

This year, while House Speaker Paul D. Ryan helped to shape the Trump proposal, the president did not show deep knowledge of the bill and relied largely on congressional Republicans to manage its progress. By contrast, Mr. Johnson mastered the details of his own legislation, and through inspiration, arm twisting and other maneuvering, pushed it through the House and Senate despite powerful opponents like the American Medical Association.

Whereas Mr. Trump tried to ram his bill quickly through the House, Mr. Johnson patiently orchestrated a six-month effort to circumvent the reefs and shoals of the legislative process. And unlike Mr. Trump, Mr. Johnson would never have dreamed of sending a White House aide to harangue his party caucus to support his bill.

Mr. Trump did little to suggest that he had an emotional commitment to transform health care in the United States. Mr. Johnson’s passion came naturally. He had suffered a near-fatal heart attack in 1955, and his life was saved by the excellent doctors at Bethesda Naval Hospital. He was keenly aware that had he not been a United States senator or otherwise well-to-do, he might well have died at age 46. ...

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