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The dance of legislation

Posted by John McDonough  February 23, 2014 07:25 PM

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Have you ever had a book you've been telling yourself to read for years, and just never get around to reading it? When you finally do, you kick yourself: what took me so long!

I just did. It's called "The Dance of Legislation" first published in 1973 by Eric Redman, a astaire.jpgwet-behind-the-ears 20-something kid who got a job in the U.S. Senate working for US Senator Warren Magnuson (D-WA) and played a pivotal role in the passage of a law in 1971 that created the National Health Service Corps (NHSC) .

It's a super book.

First, it's an insider's look at the legislative process on Capitol Hill in the first term of the presidency of Richard M. Nixon. Repeatedly, throughout the legislative process, the NHSC bill was inches away from death for reasons serious and spurious. While life in the U.S. Senate has changed in innumerable ways over the past 41 years, essential dynamics remain in play: the power of ideas, the rewards of persistence, the unpredictable twists and turns, good and bad, that spell the difference between a bill's life and death. If you like policy and politics, this is an unstoppable page-turner that often provokes laugh-out-loud moments. And if you think that the legislative maneuver called the "pocket veto" is as dull as it gets, you won't say that after reading a nail-biting conclusion.

Second, it's a compelling look at US health politics in the Nixon era, when Medicare and Medicaid were just kids, about six years old each. It's no secret that Nixon had it in for both the Surgeon General and the US Public Health Service -- the intended location for the NHSC in Magnuson's bill, S.4102. Meanwhile, SG and PHS supporters decided that S.4102 was the best available tool to fend off the Nixon Administration's offensive and to put health care back on the nation's agenda.

dance-of-legislation.jpgThird, it's an illuminating look back at a genuinely crazy time in American politics. In the middle of the effort to promote S.4102, the Nixon Administration invaded Cambodia, greatly expanding the scope of the Southeast Asian war, and turning Congress upside down for two full months. And who among you remembers something called the "SST" or supersonic transport, the U.S. attempt to build a super-fast commercial jet that divided the nation and led to one of the first-ever non-Southern state filibusters in the Senate in late 1970.

And, of course, there's a straight-line connection to today and the Affordable Care Act. The NHSC did get established and has survived and grown as a way for newly minted physicians and others to get their medical debt paid off as they provide two years of service to medical shortage areas in rural and urban America. The ACA gave the NHSC its largest financial boost ever, raising the number of slots from around 3,000 to around 10,000 today. It's now a proud and durable part of the US health infrastructure and a tribute to the late Senator Magnuson who died in 1989.

We always tend to think that our own times are the nuttiest ever. Not necessarily so. Please don't wait as long as I did to get around to discovering this treasure of a book.  If you love health care politics and policy, this is a must-read!

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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