Academic journal article Presidential Studies Quarterly

Presidential Leadership or Structural Constraints? the Failure of President Carter's Health Insurance Proposals

Academic journal article Presidential Studies Quarterly

Presidential Leadership or Structural Constraints? the Failure of President Carter's Health Insurance Proposals

Article excerpt

This study explores presidential leadership in domestic policy by assessing how Jimmy Carter, working with a Democratic majority in Congress, dealt with health care reform. This article will explore how the personal style, organizational arrangements, and leadership abilities of the president and his advisers affected the legislative success of his health program. These factors will be contrasted with structural constraints--political, economic, and institutional--as explanations for the failure of President Carter's national health program. The article begins with an overview of previous assessments of Carter's leadership as it affected his activities in office. I then respond to Gary Reichard's call to test assumptions about Carter's leadership against the detailed record from the archives of the Carter presidential libraries.(1) Several key themes will be analyzed: presidential leadership in Congress, timing of proposals, administration unity, congressional alliances, and flexibility in negotiations. The article also assesses how contingencies and crises in the economy and politics constrained leadership. The author evaluates a view of Carter as ineffectual (an "agency" approach) and as a president constrained by uncontrollable political and economic conditions (a "structuralist" alternative). This analysis raises doubts over Carter's commitment to health reform and questions whether his inaction reflected his preference for limited action, not bold initiatives, in this field.

Jimmy Carter as the "Principled Outsider"

Assessments of Carter often focus on his personality and psychology as the "principled outsider." Carter displayed a disdain for politics as usual and a strong sense of a leader's responsibility to speak for the "public interest" and to eschew concessions to powerful interests.(2) During the 1976 election campaign, Carter ran as a challenger to the insiders in Washington and the moral degeneration that had developed within government in the Watergate era. Carter drew on popular disaffection with government and alarm over the power of narrow interests.(3) But Carter also had to bring traditional Democratic constituencies into a winning coalition and consequently had to deal with them once elected. His effort to maintain relations with powerful interests and yet to convince the public of his sincere plan to reform the system contributed to an appearance of vacillation. Many analysts argue that his preference for challenging rather than placating special interests, and for principled stands rather than pragmatic programs, led to his failures on issues like health care. Preoccupied with self-interested factions in Congress, Carter could not accommodate them, a critical problem in a post-Watergate Congress, with many "resurgent and individualistic" leaders.(4)

Carter's decision-making style emphasized extensive study and evaluation of options, aiming at a consensus in favor of a comprehensive, rational solution. Carter insisted on thorough and wide-ranging investigations and discussions among diverse actors with competing views. He felt that reasoned study and discussion would produce solutions to complex problems even where competing principles were at work He did not favor concessions to legislators or interests, and "compromise was acceptable only after an all out effort to sell the optimal policy had failed."(5) Carter did not base public appeals on a vision of social justice, focusing on a more pragmatic managerialism. He used populist appeals to the poor, conservative rhetoric respecting rural and family values, and modernization themes. His philosophy combined Christian humanitarianism with scientific inquiry. This makes it difficult to typecast his views and produces charges of deviation from principles. Carter's centrist orientation made him resist attempts to steer administration policies to the Left or Right. This created dilemmas for Carter, who sought solutions that balanced popular interests with fiscal responsibility, reflecting the post-oil crisis malaise and the impact of Vietnam and the Great Society. …

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