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Remember Yesterday – The Day The “Full Biden” Emerged From Behind the Screen.

Posted on | September 10, 2021 | 8 Comments

Mike Magee

Yesterday, President Biden made clear he had had enough of McCarthy and Abbott and DeSantis.  “We’ve been patient, but our patience is wearing thin”, were his words. The politics of the moment – muscular, clear, and calculated – were reminiscent of another veteran politician and President, Lyndon B. Johnson.

Johnson brought to the task an encyclopedic knowledge of the federal legislative system, an energy that knew no bounds, and a skill set and style of negotiation that colleagues referred to as the “Full Lyndon.” As Hubert Humphrey said, “He’d come on just like a tidal wave. He went through the walls. He takes a whole room over just like that.”

The Full Lyndon involved using the full scope of his six-foot-four, 250-pound frame to tower over people in such close quarters that they felt both physically overwhelmed and verbally intimidated. Various victims subjected to this unpleasant treatment over the years described clutches, patting, pushing, and bumping intermixed with threats, promises, and flattery.

By May 1964, six months after Kennedy’s death, Johnson had captured the moral high ground for his “Great Society,” which would now include the commitments that had been made within the dead president’s New Frontier. It was about the “quality of our American civilization.” A few weeks later, on July 2, 1964, President Johnson signed the Civil Rights Act. A month later, he launched the War on Poverty. The third leg to the “martyr’s cause” was Medicare.

The presidential contest of 1964 between Johnson and Barry Goldwater was a landslide for the Democrats. Johnson received 61 percent of the roughly 70 million votes cast, and 486 electoral votes to Goldwater’s 52.57 The AMA, which had very publicly run a “Doctors for Goldwater” PR campaign, had egg on its face.

On July 30, 1965, Johnson flew to Independence, Missouri, to celebrate the passage of Medicare with Harry and Bess Truman at his side. In his remarks, he said, “It was really Harry Truman of Missouri who planted the seeds of compassion and duty which have today flowered into care for the sick and serenity for the fearful. . . . Many men can make many proposals. Many men can draft many laws. But few . . . have the courage to stake reputation, and position, and the effort of a lifetime upon a cause when there are so few that share it.”

However, as Johnson flew back to Washington, he knew that the success of Medicare was by no means assured. He had given President Truman the first Medicare card, but now, 19 million other potential recipients needed to be enrolled. The administration had only 11 months before the program would go live, and the scope of the communications and public education challenge was unprecedented, with doctors threatening to boycott the program, and Southern states threatening to resist it.

In the 1960s, hospitals throughout the South still maintained segregated restrooms and segregated floors and wards designed to separate black and white populations. The passage of the Civil Rights Act in July 1964 had sent a clear warning: Title VI of the bill stated, “No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, denied benefits of, or be subject to discrimination under any program receiving federal assistance.”

As a result, all hospitals, in order to qualify for federal Medicare certification, would have to prove that they were no longer segregating patients. Johnson’s first steps were by the book, deploying 1,000 federal inspectors across the country to ensure that the letter of the law was being implemented. Even with this, 10 months after Medicare had been signed into law, and a month or two before the launch date, half the hospitals inspected in 12 Southern states thumbed their noses in defiance with the support of their Southern governors.

Johnson called a special cabinet meeting and leaned heavily on his work horse vice president, Hubert Humphrey, to head south and communicate directly with every mayor in the noncompliant Southern cities that he was no longer screwing around. (Years later President Obama would entrust his own Vice President, Joe Biden, to go onsite and face off similar blowhards when needed.)

By May 23, 1966, all hospitals were compliant except in Alabama, Louisiana, Mississippi, and South Carolina. By July, they were clearly heading in the right direction, though 320 hospitals had not yet completed the conversions. Though some would still lag behind on the day Medicare went live on July 1, 1966, all would soon comply.

At the same time, the President himself focused on herding in recalcitrant physicians. Johnson saw this challenge as one only he could address. As the Senate was closing in on final approval of Medicare, in early June 1965, AMA president James Appel called the White House to request a meeting. It was scheduled on June 29, the day the Senate would vote its final approval of the bill.

When the delegation arrived with Dr. Appel in the lead, Johnson began by reading them verbatim from the proposed bill: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided.” He spent the next half of the meeting “hugging” the doctors, thanking them for their service, day and night, to patients “like his daddy.” He expressed his respect and gratitude for their devoted and selfless service, then asked whether they would be able to help him round up some doctors to address the pressing needs of the war-ravaged Vietnamese people.

The response was unconditional from the doctors—they were at the president’s and the nation’s service. Johnson then immediately pivoted, calling for “a couple of reporters,” who arrived quickly on cue. Johnson praised the doctors and their leaders by name, and the reporters not surprisingly wanted to know whether the AMA intended to support Medicare. Johnson interrupted, visibly shocked by the question. “These men are going to get doctors to go to Vietnam where they might get killed. . . . Medicare is the law of the land. Of course they’ll support the law of the land. Tell him, you tell him,” he said, pointing directly at the AMA leader. Appel had no choice but to confirm their support, stating modestly, “We are, after all, law abiding citizens.”

What the country witnessed yesterday was a journey man politician at work. Addressing members of the same crowd LBJ faced off fifty-five years ago, he said, “Instead of encouraging people to get vaccinated and mask up, they are ordering mobile morgues for the unvaccinated dying from Covid in our communities. This is totally unacceptable.”

Remember yesterday – the day you saw the “Full Biden” emerge from behind the screen.

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See CODE BLUE: Inside the Medical Industrial Complex (chapter7) for references and more.

Comments

8 Responses to “Remember Yesterday – The Day The “Full Biden” Emerged From Behind the Screen.”

  1. Msgr. Charles Fahey
    September 10th, 2021 @ 12:52 pm

    Thank you< once again.
    Chuck

  2. Mike Magee
    September 10th, 2021 @ 1:45 pm

    Thanks, Chuck. Happy Fall!

  3. Dan Ostergaard
    September 10th, 2021 @ 6:06 pm

    Wow, Mike, this juxtaposition of LBJ and medical history with Biden and his “Full LBJ” is wonderful!
    And similar thanks also for your series on two other luminaries,Koop and Fauci. Both vilified by some and deemed medical heroes by me.
    Dan Ostergaard

  4. Lawrence Williams
    September 10th, 2021 @ 11:04 pm

    Thanks Mike. Fascinating comparison of LBJ and Joe Biden. Never knew you were such a historian.

    It is so sad that after more than 55 years we are still fighting to try to protect the health of our citizens from the actions of unscrupulous politicians who put their own perceived political advantage ahead of the life saving needs of their constituents.

  5. Joshua Sands
    September 11th, 2021 @ 9:14 am

    Thanks Mike for a great history lesson. Many do not remember how tightly racism was/is woven into US society and the role of the federal government played in eating away at hard core segregation. This is especially important as Texas tries to assert states rights in an effort to suppress woman’s rights. I am a huge fan of your blog!

  6. Mike Magee
    September 11th, 2021 @ 1:47 pm

    Thanks, Josh! I agree that health care financing by the Federal government remains a critical (under-utilized) lever for prudent reform. Carrots are fine, but not that appetizing without the stick. LBJ (and hopefully Biden) know when and ow to use both.

  7. Mike Magee
    September 11th, 2021 @ 1:52 pm

    Thanks, Larry. The states rights battle goes back to the beginning. They thought they had it resolved in 1787 but left huge huge loopholes for the Anti-Federalists. I’ll be covering this in a Fall course – Health Care Rights and the US Constitution. (https://securelb.imodules.com/s/1878/lg21/form.aspx?sid=1878&gid=2&pgid=1306&cid=3139&srce=WBpcfall2021) Best, Mike

  8. Mike Magee
    September 11th, 2021 @ 1:57 pm

    Thanks so much, Dan! Wonderful to hear your voice. I think of you and Doug often when reflecting on the values of strong, progressive health care leadership. Best, Mike

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