Some interesting history from Peter Bourne, who was Carter's senior
health policy advisor (you could also refer to pages 432-436 in his book
Jimmy Carter: From Plains to Post Presidency ( Simon and Schuster, 1995)
in which he writes in more detail about the Carter/Kennedy conflict):
________________________________
The broad strokes on the Carter health policy are as
follows.:
When he was growing up there was no doctor in the county where his
father
farmed (for blacks or whites). The whites had mobility (and money) so
could
go to nearby communities to see a physician. Carter's mother, a nurse,
provided the only health care for most black families. Carter therefore
developed a great interest in health and particularly the lack of it
among
the poor. As governor of Georgia he was greatly interested in
interventions
the state government could that make would effect the health of people
such
as reducing infant mortality, reducing substance abuse, improving
nutrition.
His initiative called the Cripplers and Killers Program was a public
health
approach geared to improving health rather than a focus on a cute
curative
care.
During the presidential campaign in 1976 he
responded
to the demand for better health care by committing to a system of
comprehensive government sponsored care. This he did primarily because
he
needed the support of the United Auto Workers (UAW). He laid out the
plan
in a speech to the black Student National National Medical Association,
but
he was very worried about over-committing especially with regard to
cost.
For a week before the speech I negotiated almost every phrase he would
say
with the top UAW people otherwise they were not prepared to endorse
him..
Carter insisted on phrases such "phasing-in as revenues permit" and
"eventual
universal coverage." Towards the end of the general election campaign he
gave a second speech to the American Public Health Association which
focused on his promise of a national public health campaign such as he
had
adopted in Georgia. It was very well received and not considered
controversial.
Once in the White House his concern about the economy
and
the need to reduce government spending transcended any commitment to
implementing comprehensive national health insurance. He continued
rhetorical support and talked with passion about people's inability to
get
care, but announced he was delaying introduction of national health care
legislation until 1978. A major political problem he faced was that Ted
Kennedy who had made himself "Mr Health Care" in the Congress was an
author
of the Kennedy-Corman bill that provided for exactly the form of
comprehensive universal coverage that progressives and, especially the
UAW,
wanted. If Carter supported it and it passed
Kennedy would get all the credit. So he condemned it as hopelessly
expensive. Yet he had no viable alternative plan of his own.
Increasingly he
stressed the need for a program of health cost containment as a first
step
towards any sort of universal coverage. A growing schism and direct
conflict
developed between Kennedy and his congressional allies, the UAW and
AFL-CIO
on the one hand and Carter on the other. It climaxed in a heated,
showdown
meeting in the cabinet room with all the principles present. Carter
refused
to back down and insisted that he was only willing to submit cost
containment legislation. I was in a very difficult position because, I
really wanted the Kennedy legislation to pass and believed it was in the
best interests of the country, but my job required that I be the primary
spokesperson and advocate for the Carter position. Kennedy later told me
that as a result of that meeting and his inability to get Carter to
budge he
made the decision to run against him in the primaries in 1980.
The cost control legislation had a chequered course in the Congress and
never went anywhere.
Apart from national health insurance Carter deserves
great
credit for the Presidential Commission on Mental Health and Mental
Illness
which was led by his wife Rosalynn and resulted in significant
legislation
benefitting the mentally ill. He was also the first president to launch
an
initiative on global health committing the US to support a variety of
programmes to reduce mortality and morbidity in the developing world
dealing
with such things as clean water and blindness. In many ways the program
became a blue-print for what he did in his post-presidency.
Obviously there is infinite detail that I have not gone
into but I hope this will help you refine your topic.
Best
Peter
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, January 19, 2009 7:57 AM
Subject: FW: Carter books or sources?
Dr. Bourne:
Thank you so much for your response. I was out of town for the weekend,
and
this was a pleasant surprise in my email box.
I'm still fine-tuning my dissertation topic - it will have something to
do
with US health policy and politics (most likely since LBJ), and perhaps
congressional relations with the White House (previously, I worked as a
Legislative Assistant on a House committee, so I have an inherent
interest
in this).
I'm right now just trying to get a base for my studies. I will
certainly
pick up your book. I hope that as I narrow in on my research topic, you
would be available for questions.
Thanks again,
Beth Goldstein
-----Original Message-----
From: Anglo-American Health Policy Network on behalf of Peter G. Bourne
Sent: Fri 1/16/2009 7:56 PM
To: [log in to unmask]
Subject: Re: Carter books or sources?
Adam,
She might find my book "Jimmy Carter: From Plains to the
Post-Presidency" published by Simon and Schuster helpful. Also if she
wants
to e-mail me I can provide some general information about Carter's
health
policy (I was head of health policy in the Carter White House.).
Best
Peter
----- Original Message -----
From: "Adam Oliver" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 16, 2009 2:04 PM
Subject: FW: Carter books or sources?
I have the following student in my class this term. Can anyone recommend
any good sources for her. I'm being lazy, I know, but I'm speaking to
the experts...
-----Original Message-----
From: Goldstein,BL (pgt)
Sent: 16 January 2009 19:03
To: Oliver,AJ
Subject: Carter books or sources?
Dr. Oliver:
I attended your US Health Policy lecture on Thursday, and mentioned to
you that I am doing my dissertation around the topic of US health policy
and the politics of reform. Would you have any recommendations for
books or other sources on Carter's attempts for reform or agenda for
health policy?
Thank you so much,
Beth Goldstein
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