In the spring of 1962, President John F. Kennedy launched a bold effort to provide health care for the aged—later to be known as Medicare. It culminated in a nationally televised presidential address from Madison Square Garden, carried on the three television networks. It was a flop. The legislation foundered amid charges that it was an attempt to socialize medicine and a threat to individual liberty—the same charges President Obama encountered over the Affordable Care Act five decades later.
While Obama crosses his fingers and waits for healthcare.gov to flicker to life, he can at least comfort himself knowing that he has already done more to reform the health care system than JFK, a president with a vigorous reputation and vibrant legacy. The Gallup poll reports that 74 percent of the country believe John F. Kennedy will go down in history as an outstanding or above-average president, a more positive review than any other post-World War II president receives.
But the story of Kennedy’s health care failure is not just about the enduring difficulty of addressing such a thorny issue. It is about how even an energetic and determined chief executive can be constrained by the limitations of the office. Kennedy's story of botched congressional relations, the limits of public persuasion, and the rise of a grassroots opposition that can match the power of the bully pulpit foreshadows many of the same problems President Obama faces today.
Kennedy took office with a grand new vision for the presidency. In September 1960, before his narrow victory over Richard Nixon, the then-senator read the first of several memos he had requested from political scientist Richard Neustadt. The Columbia professor had just published his seminal work Presidential Power, which offered a new theory on how a president, limited by the Constitution, can still succeed through personal persuasion, backroom maneuvering, and public prestige. Kennedy was in a hurry to put its thinking into action. By using the right formula, he could achieve the greatness he craved. Days before taking the oath, he outlined his approach to the National Press Club. Eisenhower had a "detached, limited concept of the presidency," he said. The 1960s required a president to "place himself in the very thick of the fight ... prepared to exercise the fullest powers of his office ... to ensure enactment of that legislation—even when conflict is the result."
Kennedy embraced conflict on Medicare. Soon after taking office, he asked Congress to move on the issue, but like Obamacare it languished while its members pawed over it. By the spring of 1962, the president had political and personal reasons to push the fight again. Kennedy's pollster Lou Harris counseled that he would need domestic accomplishments for his re-election and that Medicare would be an important one. The issue was also essential for the AFL-CIO, a key Democratic Party ally, and so could be incredibly helpful for Democrats facing election that year.
Kennedy had his eye on his legacy, too. That's usually a topic for a president's second term, but Kennedy was always in a hurry. JFK, who repeatedly referred to the gravity of foreign policy issues, also thought the measure of a great president was how much of his agenda had been pushed through Congress. He quibbled with presidential rankings that had put Teddy Roosevelt and Woodrow Wilson ahead of Harry Truman and James Polk, who had actually achieved more. "[P]eople who educated the nation without necessarily accomplishing their particular purposes rated, in his judgment, below those who accomplished their purposes without necessarily bringing the nation along with them," wrote Arthur Schlesinger Jr. in A Thousand Days, his chronicle of his time in the Kennedy administration.
Inside the administration they debated how to proceed. Should the president's aides play the inside legislative game or should the president build public pressure that would force members of Congress to act? Wilbur Mills, the powerful chairman of the House Ways and Means Committee, had blocked the legislation, and Kennedy had to treat Mills carefully. He was the gatekeeper for all of Kennedy’s policy priorities, from taxes to trade to foreign aid. But Mills had sent signals that he might allow Medicare to sneak in under the cloak of a welfare bill, which Mills wanted to pass. Medicare would be added to the bill in the Senate, and then Mills could water it down in the conference committee where the House and Senate versions of the welfare bill were reconciled.
It was a plausible strategy, but some on Kennedy's staff and the AFL-CIO wanted a public fight to get a stronger bill. Since the dawn of the television age, every president has faced this inside-outside tension, with presidents and their staff putting more and more stock in their ability to rally the country. It was also President Obama's main legislative strategy.
Kennedy, who faced this presidential conundrum in its infancy, decided to follow both routes, working to persuade on the inside but also "going public"—over the heads of Congress and directly to the voters—to create pressure in Washington. He was determined to take control of his office and he had cause to press his advantage. The New York Times reported on the eve of the fight that members of Congress “on the whole appear to be far friendlier toward him and his program than at any other time since the session began in 1961. This results chiefly from the growing election-year sensitivity to Mr. Kennedy's popular influence in the country. Even Republicans are sensitive to this influence."