White House Studies Compendium

WHITE HOUSE STUDIES COMPENDIUM, VOLUME 5

WHITE HOUSE STUDIES COMPENDIUM, VOLUME 5

ROBERT W. WATSON EDITOR

Nova Science Publishers, Inc. New York

Copyright © 2008 by Nova Science Publishers, Inc.

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ISBN-13: 978-1-60692-761-8

Published by Nova Science Publishers, Inc.

New York

CONTENTS Preface

ix

Health Care Initiatives and the Modern Presidency Bryan Hilliard and Richard M. Yon

1

Presidents and the Development of Medicare in the United States Max J. Skidmore

23

President Bush and Stem Cell Policy: the Politics of Policy Making Kant Patel and Mark Rushefsky

35

The ‘Blame Game’: What Went Wrong with Health Care Reform Gary D. Wekkin

51

The Influence of First Ladies on Mental Health Policy Jerome L. Short, Colleen J. Shogan and Nicole M. Owings

63

The George W. Bush Presidential Transition: The Disconnect between Politics and Policy Anthony J. Eksterowicz and Glenn P. Hastedt

75

The White House Budget – What It Isn’t, What It Is: And A Five-Year Comparison Bradley H. Patterson

91

Are all Presidential Legislative Successes Really Victories? Examining the Substance of Legislation Andrew W. Barrett

101

Revisiting El Dorado Canyon: Terrorism, the Reagan Administration, and the 1986 Bombing of Libya David B. Cohen and Chris J. Dolan

121

Could You Spare a Dime? Better Make it $10,000: Contributions to the Clinton Legal Expense Trust Israel Waismel-Manor and Shelley Conroy

143

vi

Contents

Learning the Art of Policy Management Bruce E. Altschuler

163

Inflation Rhetoric: Gerald Ford’s First Six Months in Office David Gore

183

Jefferson Davis, Religion, and the Politics of Recognition D. Jason Berggren

199

George Washington’s Leadership Style and Conflict at the Federal City John C. Pinheiro

211

The Presidency of Ulysses S. Grant: A Reconsideration Max J. Skidmore

221

Lessons From the First Great American Presidents: An Introduction William D. Pederson and Frank J. Williams

237

Abraham Lincoln’s George Washington Ronald D. Rietveld

241

Abraham Lincoln’s Thomas Jefferson Ronald D. Rietveld

279

Washington’s Farewell Address and Lincoln’s Lyceum Address Joseph R. Fornieri

317

Jefferson, Lincoln and Religious Freedom Rodney A. Grunes

335

Invoking the Framers: The Lincoln-Douglas Debates Danny M. Adkison

353

Lincoln, Seward and the United Kingdom Scott Crichlow

363

Thomas Jefferson, Abraham Lincoln and Civil Liberties: The Balance of Liberty and Security Frank J. Williams Ex Parte Milligan: Lincoln’s Use of Military Commissions Joseph R. Thysell, Jr. The Rectitude of Their Intentions: Proclaiming Independence in Philadelphia and Tel Aviv Norman Provizer and Claire Wright Beyond Maternalism: Women and the Spaces of Political Leadership Marsha Marotta A Role Model for Twenty-First Century Presidential Politics: Condoleezza Rice Ronald D. Petitte

375 395

409 425

437

Contents Embracing the Next Generation: How Young Women Can Help Elect Our First Woman President Marni Schultz

vii

449

Media Coverage of Women Candidates Jessica Aubin, Michelle Haak and Andrew Mangini

471

Experiences of Female Presidential Candidates Alicia Jencik

487

Countdown to Iowa Mosemarie Boyd

505

Monetizing the Audience: Campaign Allocation Strategies David M. Keithly

511

Book Reviews

519

The Law and Order Presidency. By Willard M. Oliver Reviewed by: Roy E. Brownell II

519

On Deaf Ears: The Limits of the Bully Pulpit. By George C. Edwards III Reviewed by: Richard S. Conley

521

Presidential Campaign Quality: Incentives and Reform. By Bruce Buchanan. Reviewed by: David A. Dulio Franklin D. Roosevelt and Abraham Lincoln: Competing Perspectives on Two Great Presidencies. Edited by William D. Pederson and Frank J. Williams. Reviewed by: Jack Lechelt The Tormented President: Calvin Coolidge, Death, and Clinical Depression. By Robert E. Gilbert Reviewed by: Glen Sussman The Challenge of the American Presidency. By Phillip Abbott. Reviewed by: Robert J. DeCastro

523

526

529 531

Fixing Intelligence for a More Secure America, 2nd Edition. By William E. Odom, Reviewed by John Davis

533

Against all Enemies:Inside America’s War on Terror. By Richard A. Clarke Reviewed by Anthony J. Eksterowicz

535

Franklin D. Roosevelt and the Transformation of the Supreme Court. By Stephen K. Shaw, William D. Pederson and Frank J. Williams, Reviewed by Bryan Hilliard

537

viii

Contents

Franklin D. Roosevelt and the Formation of the Modern World. By Thomas C. Howard, William D. Pederson, Editors. Reviewed by Sondra Pena

539

The Nerve Center: Lessons in Governing from the White House Chiefs of Staff. By Terry Sullivan, Reviewed by Michael Frabotta

542

Reagan’s Revolution: The Untold Story of the Campaign That Started it All. By Craig Shirley. Reviewed by Peter Hannaford

543

The War for Righteousness: Progressive Christianity, the Great War, and the Rise of The Messianic Nation. By Richard M. Gamble Reviewed by Michael W. Popejoy

545

Power and Prudence: The Presidency of George H.W. Bush. by Ryan J. Barilleaux and Mark J. Rozell. Reviewed by: Jeremy B. Johnson

549

About the Contributors

553

Index

561

PREFACE The American presidency has become one of the most powerful offices in the world with the ascendency of American power in the 20th century. “White House Studies Compendium” brings together piercing analyses of the American presidency - dealing with both currect issues and historical events. The compendia consist of the combined and rearranged issues of “White House Studies” with the addition of a comprehensive subject index.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 1-21

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

HEALTH CARE INITIATIVES AND THE MODERN PRESIDENCY

Bryan Hilliard and Richard M. Yon ABSTRACT We catalogue significant activities and specific Executive Orders relating to health care and healthcare policy from Franklin D. Roosevelt through the first three years of George W. Bush’s term in office. As the federal government’s role in health care has expanded, presidents have had, and continue to have, significant impact on policies and regulations that in turn affect individual and public health care in the United States. No doubt, other factors such as the influence of powerful special interest groups, legislative intent, and judicial oversight may alter presidential initiatives. Yet presidents, especially those of the modern era, have immense prestige and power to influence policies related to American health. Any assessment — ethical, political, and social — of a particular chief executive’s effectiveness in influencing health policy begins with knowledge of specific policies and initiatives (those that have succeeded as well as those that have failed) undertaken by the White House. This list is by no means exhaustive, and some may quarrel with particular items, but it should provide a foundation for understanding presidential priorities regarding individual public health measures. Also, it is hoped that this catalogue provides an historical perspective for continued discussions on the ethical obligations presidents have in shaping health care policy.

INTRODUCTION In 1798 President John Adams signed the Act for Sick and Disabled Seamen. This legislation passed by the 5th Congress provided for the care of seamen in existing facilities, and the building of hospitals where there were none, with financing to come from deductions from seamen’s wages. Debate over the bill was intense. Supporters noted that the states would have to assume the burden of care if the federal government did not act. Opponents argued that seamen were no different from other sick and disabled individuals who could not take care of themselves, and thus should rely on charity care, not the government. President

2

Bryan Hilliard and Richard M. Yon

Adams’ signature on the legislation represented the first action in what would become a long history of federal involvement in, and presidential initiatives concerning, the nation’s health.1 The next 206 years saw a dramatic increase in federal involvement in policies directed at the personal and public health needs of the nation. This federal role involved many players, including Congress, the judiciary, various administrative and regulatory agencies, several offices and councils inside the White House, and the presidency itself. The years following the presidency of John Adams also witnessed a great deal of debate centered on the degree to which the federal government should participate in matters related to the nation’s health. While no one today seriously maintains that government has no role, considerable disagreement exists over the proper scope of such involvement. Lack of consensus regarding regulatory, financial, and legal control in matters related to health has resulted in many of the efforts of the federal government becoming incremental. Since the beginning of the modern presidency, debate over federal control of programs and policies designed to protect and promote the health of Americans has intensified. Problems related to financing, access, distributive justice, and what constitutes proper government intervention have occupied, to one degree or another, all presidents from FDR to George W. Bush. Regardless of whether a particular piece of legislation or initiative can be characterized as incremental or comprehensive, modern presidents have had a direct impact on health care policy. In some cases, presidential involvement was voluntary, influenced by a set of ideals, and motivated by a sense of justice. In other cases, presidents found themselves forced to act, either from political expediency, or as a result of overwhelming events. As the current crisis in America’s system of healthcare financing and delivery deepens, the next occupant of the White House will continue to face many of the same challenges encountered by previous occupants as well as new challenges stemming from advances in technology and threats of bioterrorism.

FRANKLIN D. ROOSEVELT (1933-1945) Selected Significant Activities In 1935 the Social Security Act was passed, thus creating the modern Social Security system. The Act included a federal/state unemployment compensation system, grants to develop public health programs, and benefits to the elderly and to poor families with dependent children. In 1935 the Works Project Administration designated funds to build hospitals and improve existing ones. In 1943 the Emergency Maternity and Infant Care Program authorized the provision of health care to wives and children of men in the military. The program was terminated in 1949.

1

Jo Ivey Boufford and Philip R. Lee, “Health Policy Making: The Role of the Federal Government,” in Ethical Dimensions of Health Policy, edited by Marion Danis, Carolyn Clancy, and Larry Churchill (New York: Oxford University Press, 2002), pp. 161-162.

Health Care Initiatives and the Modern Presidency

3

Selected Executive Orders EO 7709-A Abolishing the National Emergency Council ƒ Signed: September 16, 1937 ƒ Amended by: EO 7776, December 27, 1937; EO 7906, June 6, 1938 EO 7710 Authorizing the Appointment of Dr. Winfred Overholse as Superintendent of St. Elizabeth’s Hospital without Regard to Civil Service Rules ƒ Signed: September 17, 1937 EO 7846 Prescribing Regulations Relating to Sick Leave of Government Employees ƒ Signed: March 21, 1938 ƒ Revoked by: EO 8385, March 29, 1940 EO 8807 Establishing the Office of Scientific Research and Development in the Executive Office of the President and Defining Its Functions and Duties ƒ Signed: June 28, 1941 ƒ Amended by: EO 9389, October 18, 1943 ƒ Superseded by: EO 9913, December 26, 1947 EO 8890 Establishing the Office of Defense Health and Welfare Services in the Executive Office of the President and Defining Its Functions and Duties ƒ Signed: September 3, 1941 ƒ See: EO 9310, March 6, 1943 EO 9039 Authorizing Sick and Rest Leave for Alien Employees of the Panama Canal and the Panama Railroad Company ƒ Signed: January 24, 1942 ƒ Revoked by: EO 9740, June 20, 1946 EO 9079 Making Certain Public Health Service Hospitals Available for the Care and Treatment of Insane Persons ƒ Signed: February 26, 1942 EO 9219 Extension of Provisions of EO 9001 of December 27, 1942, to the Office of Scientific Research and Development in the Office for Emergency Management ƒ Signed: August 11, 1942 ƒ Amended by: EO 9296, January 20, 1943 ƒ Note: The authority of this Executive Order was repealed by Pub. L. 89-554 (80 Stat. 651). EO 9280 Delegating Authority with Respect to the Nation's Food Program ƒ Signed: December 5, 1942 ƒ Amends: EO 8734, April 11, 1941; EO 8942, November 19, 1941; EO 9023, January 14, 1942; EO 9040, January 24, 1942; EO 9125, April 7, 1942; EO 9138, April 17, 1942 ƒ Amended by: EO 9334, April 19, 1943; EO 9392, October 28, 1943; EO 9915, December 30, 1947 ƒ Note: The Administrations established in this Executive Order were terminated by EO 9577, June 29, 1945. EO 9310 Transferring the Nutrition Functions of the Office of Defense Health and Welfare Services to the Department of Agriculture ƒ Signed: March 6, 1943

4

Bryan Hilliard and Richard M. Yon EO 9322 Centralizing and Delegating Authority with Respect to the Production and Distribution of Food ƒ Signed: March 26, 1943 EO 9411 Prescribing Rates for Hospitalization and Medical Care of Dependents of Naval Personnel and Others ƒ Signed: December 23, 1943 ƒ Revoked by: EO 11116, August 5, 1963 EO 9414 Regulations Relating to Annual and Sick Leave of Government Employees ƒ Signed: January 13, 1944 ƒ Note: The authority of this Executive Order was repealed by the Annual and Sick Leave Act of 1951. EO 9454 Temporary Appointments as Officers in the Army of the United States of Members of the Army Nurse Corps and Female Dietetic and Physical-Therapy Personnel of the Medical Department of the Army ƒ Signed: July 10, 1944 EO 9498 Amending Executive Order 9079 of February 26, 1942, Making Certain Public Health Service Hospitals Available for the Care and Treatment of Insane Persons ƒ Signed: November 11, 1944

HARRY S. TRUMAN (1945-1953) Selected Significant Activities In 1946 Congress passed the Hospital Survey and Construction Act (Hill-Burton Act). The legislation was designed to assist states in building hospitals. In 1954 the Act was amended to provide funding for the construction of long-term care facilities, rehabilitation centers, and outpatient departments.2 On January 6, 1947, in his State of the Union address, Truman called for a national health insurance program that would include support for mental health, childcare, and hospital construction.3

Selected Executive Orders EO 9568 Providing for the Release of Scientific Information ƒ Signed: June 8, 1945 ƒ Amended by: EO 9604, August 25, 1945; EO 9809, December 12, 1946 EO 9575 Declaring the Commissioned Corps of the Public Health Service to Be a Military Service and Prescribing Regulations Therefore ƒ Signed: June 21, 1945 ƒ Superseded by: EO 13049, April 26, 1952

2 3

See http://indylaw.edu/healthlw David McCullough, Truman (New York: Simon & Schuster, 1992), pp. 473-474.

Health Care Initiatives and the Modern Presidency

5

EO 9655 Regulations Relating to Commissioned Officers and Employees of the Public Health Service ƒ Signed: November 14, 1945 ƒ Amended by: EO 9897, October 10, 1947 ƒ Revoked by: EO 9993, August 31, 1948 EO 9680 Abolishing the United States of America Typhus Commission ƒ Signed: January 17, 1946 EO 9703 Regulations Relating to the Medical Care of Certain Personnel of the Coast Guard, Coast and Geodetic Survey, Public Health Service, and Former Lighthouse Service ƒ Signed: March 12, 1946 ƒ Amended by: EO10122, April 15, 1950; EO 10400, September 27, 1952; EO 11160, July 6, 1964 EO 9708 Specifying Communicable Diseases for the Purpose of Regulations Providing for the Apprehension, Detention, or Conditional Release of Individuals to Prevent the Introduction, Transmission, or Spread of Communicable Diseases ƒ Signed: March 26, 1946 ƒ Amended by: EO10532, May 28, 1954; EO 11070, December 12, 1962 ƒ Revoked by: EO 12452, December 22, 1983 EO 9791 Providing for a Study of Scientific Research and Development Activities and Establishing the President's Scientific Research Board ƒ Signed: October 17, 1946 ƒ Amended by: EO 9809, December 12, 1946 ƒ Note: EO 9841 terminated the office, April 23, 1947. EO 9993 Regulations Relating to Commissioned Officers and Employees of the Public Health Service ƒ Signed: August 31, 1948 ƒ Revokes: EO 9655, November 14, 1945; EO 9879, October 10, 1947; EO 9955, May 6, 1948 ƒ Amended by: EO 10031, January 26, 1949; EO 10280, August 16, 1951; EO 10354, May 26, 1952; EO 10497, October 27, 1953; EO 10506, December 10, 1953 ƒ Revoked by: EO 11140, January 30, 1964 EO 10014 Directing Federal Agencies to Cooperate with State and Local Authorities in Preventing Pollution of Surface and Underground Waters ƒ Signed: November 3, 1948 ƒ Superseded by: EO 11258, November 7, 1965 EO 10122 Regulations Governing Payment of Disability Retirement Pay, Hospitalization, and Re-Examination of Members and Former Members of the Uniformed Services ƒ Signed: April 14, 1950 ƒ Amended by: EO 10400, September 27, 1952; EO 11733, July 30, 1973

6

Bryan Hilliard and Richard M. Yon EO 10166 Establishing the National Advisory Committee on the Selection of Doctors, Dentists, and Allied Specialists ƒ Signed: October 4, 1950 ƒ Amended by: EO 10185, December 1, 1950 ƒ Revoked by: EO 11415, June 24, 1968 EO 10194 Establishing the Federal Safety Council ƒ Signed: December 19, 1950 ƒ Revokes: EO 8071, March 21, 1939 ƒ Superseded by: EO 10990, February 2, 1962 EO 10262 Suspension of Professional Examinations for Promotion of Medical, Dental, and Veterinary Officers in the Regular Army and Air Force ƒ Signed: June 28, 1951 ƒ Note: See Pub. L. 94-412 (90 Stat. 1255), which terminated, effective September 4, 1978, all powers and authorities, except those expressly cited, possessed by the President and/or other Federal officials as a result of any declaration of a national emergency in effect on September 14, 1976. EO 10302 Interdepartmental Committee on Narcotics ƒ Signed: November 2, 1951 ƒ Revoked by: EO 11529, April 24, 1970 EO 10317 Establishing the President's Commission on the Health Needs of the Nation ƒ Signed: December 29, 1951 EO 10356 Continuing the Commissioned Corps of the Public Health Service as a Military Service ƒ Signed: May 29, 1952 EO 10399 Designating the Surgeon General of the Public Health Service to Perform Certain Duties under the International Sanitary Regulations ƒ Signed: September 27, 1952 EO 10400 Amending EO 10122 of April 14, 1950, entitled "Regulations Governing Payment of Disability Retirement Pay, Hospitalization, and Re-Examination of Members and Former Members of the Uniformed Services" ƒ Signed: September 27, 1952

DWIGHT D. EISENHOWER (1953-1961) Selected Significant Activities In 1954 Eisenhower proposed a comprehensive health and welfare plan that included a proposal to re-insure private health insurance companies against losses. Congress rejected the plan.4 Also, in 1954, the Internal Revenue Code was amended to exempt employer purchased health benefits from taxable income. In 1956 Eisenhower oversaw the expansion of Social Security benefits to include the disabled.5 And, in 1956 the federal government established 4 5

See http://indylaw.edu./healthlw Ibid.

Health Care Initiatives and the Modern Presidency

7

the Civilian Health & Medical Program of the Uniformed Services (CHAMPUS). This program extended benefits to military dependents in civilian medical facilities.

Selective Executive Orders EO 10506 Delegating Certain Functions of the President under the Public Health Service Act ƒ Signed: December 10, 1953 ƒ Superseded by: EO 11140, January 30, 1964 EO 10510 Establishing a Seal for the Department of Health, Education, and Welfare ƒ Signed: December 17, 1953 EO 10532 Amendment of the List of Communicable Diseases Contained in EO 9708 of March 26, 1946 ƒ Signed: May 28, 1954 ƒ Revoked by: EO 12452, December 22, 1983 ƒ See: EO 11070, December 12, 1962 EO 10555 Establishing a Seal for the President's Committee on Employment of the Physically Handicapped ƒ Signed: August 23, 1954 EO 10640 The President's Committee on Employment of the Physically Handicapped ƒ Signed: October 10, 1955 ƒ Superseded by: EO 10994, February 14, 1962 EO 10673 Fitness of American Youth ƒ Signed: July 16, 1956 ƒ Amended by: EO 10704, March 25, 1957; EO 10740, November 21, 1957; EO 10772, June 30, 1958; EO 10785, October 17, 1958; EO 10931, March 29, 1961 ƒ Revoked by: EO 11074, January 8, 1963 EO 10779 Directing Federal Agencies to Cooperate with State and Local Authorities in Preventing Pollution of the Atmosphere ƒ Signed: August 20, 1958 ƒ Superseded by: EO 11282, May 26, 1966 EO 10807 Federal Council for Science and Technology ƒ Signed: March 13, 1959 ƒ Revokes: EO 9912, December 24, 1947 ƒ Amended by: EO 11381, November 8, 1967 ƒ See: Pub. L. 94-282 (90 Stat. 472) (Council abolished) ƒ Note: The Council was physically located at the National Science Foundation. NSF assumed the functions of the old Office of Science and Technology under Reorganization Plan 1 of 1973. EO 10858 The President's Committee for Traffic Safety ƒ Signed: January 13, 1960 ƒ Revoked by: EO 11382, November 28, 1967

8

Bryan Hilliard and Richard M. Yon

JOHN F. KENNEDY (1961-1963) Selective Significant Activities In 1962 the Migrant Health Act was enacted, providing federal funding to migrants for health services. On January 11, 1963, in his State of the Union address, Kennedy called for the creation of the National Institutes of Health. Also, in early 1963, he spoke out forcefully for health reform legislation and health insurance for seniors.6 In 1963 the Mental Retardation Facilities and Community Mental Health Centers Construction Act was enacted. See Pub. L. 88-164.

Selected Executive Orders EO 10914 Providing for an Expanded Program of Food Distribution to Needy Families ƒ Signed: January 21, 1961 EO 10994 The President's Committee on Employment of the Handicapped ƒ Signed: February 14, 1962 ƒ Supersedes: EO 10640, October 10, 1955 ƒ Superseded by: EO 11480, September 9, 1969 EO 11001 Assigning Emergency Preparedness Functions to the Secretary of Health, Education, and Welfare ƒ Signed: February 16, 1962 ƒ Revoked by: EO 11490, October 28, 1969 EO 11022 Establishing the President's Council on Aging ƒ Signed: May 14, 1962 ƒ Amended by: EO 11376, October 17, 1967; EO 12106, December 28, 1978 ƒ Revoked by: EO 12379, August 17, 1982 EO 11060 Prescribing Certain Regulations and Delegating to the Attorney General Certain Authority of the President to Prescribe Other Regulations Relating to the Recovery from Tortuously Liable Third Persons of the Cost of Hospital and Medical Care and Treatment Furnished by the United States ƒ Signed: November 7, 1962 ƒ Amended by: EO 12608, September 9, 1987 EO 11070 Amendment of the List of Communicable Diseases Contained in EO 9708 of March 26, 1946, as Amended by EO 10532 of May 28, 1954 ƒ Signed: December 12, 1962 ƒ Revoked by: EO 12452, December 22, 1983 EO 11074 Establishing the President's Council on Physical Fitness ƒ Signed: January 8, 1963 ƒ Amends: EO 10830, July 24, 1959 ƒ Revoked by: EO 11398, March 4, 1968

Health Care Initiatives and the Modern Presidency

9

EO 11076 Establishing the President's Advisory Commission on Narcotic and Drug Abuse ƒ Signed: January 15, 1963 EO 11116 Prescribing Rates of Charges for Certain Hospitalization and Dispensary Services and Delegating Authority to Prescribe Such Rates ƒ Signed: August 5, 1963 ƒ Revokes: EO 9411, December 23, 1943 ƒ Amends: EO 10530, May 10, 1954 ƒ Superseded in part by: EO 11230, June 28, 1965 ƒ Revoked by: EO 12553, February 25, 1986

LYNDON B. JOHNSON (1963-1969) Selected Significant Activities In 1964 the Surgeon General released the first report on smoking and health. On July 30, 1965, President Johnson signed the Medicare Act into law.

Selected Executive Orders EO 11140 Delegating Certain Functions of the President Relating to the Public Health Service ƒ Signed: January 30, 1964 ƒ Supersedes: EO 10506, December 10, 1953 ƒ Amended by: EO 12608, September 9, 1987 EO 11258 Prevention, Control, and Abatement of Water Pollution by Federal Activities ƒ Signed: November 17, 1965 ƒ Supersedes: EO 10014, November 3, 1948 ƒ Superseded by: EO 11288, July 2, 1966 EO 11279 Establishing the President's Committee on Health Manpower and the National Advisory Commission on Health Manpower ƒ Signed: May 7, 1966 EO 11280 Establishing the President's Committee on Mental Retardation ƒ Signed: May 11, 1966 ƒ Superseded by: EO 11776, March 28, 1974 EO 11282 Prevention, control, and abatement of air pollution by Federal Activities ƒ Signed: May 26, 1966 ƒ Supersedes: EO 10779, August 20, 1958 ƒ Superseded by: EO 11507, February 4, 1970

6

Robert Dallek, An Unfinished Life: John F. Kennedy 1917-1963 (Boston: Little, Brown and Company, 2003), pp.

10

Bryan Hilliard and Richard M. Yon EO 11357 Administration of the National Traffic and Motor Vehicle Safety Act through the National Highway Safety Bureau and its Director ƒ Signed: June 6, 1967 ƒ See Pub. L. 91-605 (84 Stat. 1739), functions vested in National Highway Traffic Safety Administration EO 11415 Reconstituting the National Advisory Committee on the Selection of Physicians, Dentists, and Allied Specialists and the Health Resources Advisory Committee ƒ Signed: June 24, 1968 ƒ Revokes: EO 10166, October 4, 1950; EO 10185, December 1, 1950 ƒ Committee continued by EO 11827, January 4, 1975; EO 11948, December 20, 1976 ƒ Revoked by EO 12148, July 20, 1979

RICHARD M. NIXON (1969-1974) Selected Significant Activities In 1971 the National Cancer Act was signed into law. In 1972 Medicare eligibility was expanded to include people under 65 who were receiving disability benefits and people with end-stage renal disease. In 1973 the Health Maintenance Organization Act was signed into law. The Nixon administration viewed the establishment of HMOs as a major health care initiative; the Act authorized federal financial support for HMOs and promoted their adoption by Employer-sponsored health plans. See Pub. L. 93-222, (87 Stat. 914).7 In 1974 the Employee Retirement Income Security Act (ERISA) was signed into law. See Pub. L. 93-406, (88 Stat. 832). ERISA is the legislation that has made the proliferation and success of managed care organizations possible. In 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was established and was active until 1978.

Selected Executive Orders EO 11472 Establishing the Environmental Quality Council and the Citizens' Advisory Committee on Environmental Quality ƒ Signed: May 29, 1969 ƒ Revokes: EO 11278, May 4, 1966; EO 11359A, June 29, 1967; EO 11402, March 29, 1968 ƒ Committee continued by: EO 11827, January 4, 1975 ; EO 11948, December 20, 1976 ƒ Committee terminated by: EO 12007, August 22, 1977

7

490-496. Eleanor Kinney, Protecting American Health Care Consumers (Durham, NC: Duke University Press, 2002), p. 132.

Health Care Initiatives and the Modern Presidency

11

ƒ See Pub. L. 91-190 (83 Stat 852) and Pub. L. 91-224 (84 Stat. 114) EO 11480 The President's Committee on Employment of the Handicapped ƒ Signed: September 9, 1969 ƒ Supersedes: EO 10994, February 14, 1962; EO 11018, April 27, 1962 ƒ Amended by: EO 12106, December 28, 1978; EO 12608, September 9, 1987 ƒ Superseded by: EO 12640, May 10, 1988 EO 11523 Establishing the National Industrial Pollution Control Council ƒ Signed: April 9, 1970 ƒ Council terminated, January 5, 1975, by Pub. L. 92-463 (86 Stat. 770) EO 11562 Developing and Coordinating a National Program for Physical Fitness and Sports ƒ Signed: September 25, 1970 ƒ Amended by: EO 11945, October 25, 1976; EO 12098, November 14, 1978 ƒ Revokes: EO 11398, March 4, 1968; EO 11492, October 30, 1969 ƒ Revoked by: EO 12345, February 2, 1982 EO 11599 Establishing a Special Action Office for Drug Abuse Prevention ƒ Signed: June 17, 1971 ƒ Nullified by: Pub. L. 92-255 (86 Stat. 65), which establishes the Special Action Office for Drug Abuse Prevention superseding this Executive order EO 11612 Occupational Safety and Health Programs for Federal Employees ƒ Signed: July 26, 1971 ƒ Superseded by: EO 11807, September 28, 1974 EO 11628 Establishing a Seal for the Environmental Protection Agency ƒ Signed: October 18, 1971 EO 11735 Assignment of Functions under Section 311 of the Federal Water Pollution Control Act, as Amended ƒ Signed: August 3, 1973 ƒ Amended by: EO 12418, May 5, 1983 ƒ Revoked by: EO 12777, October 18, 1991 EO 11738 Providing for Administration of the Clean Air Act and the Federal Water Pollution Control Act with Respect to Federal Contracts, Grants or Loans ƒ Signed: September 10, 1973 ƒ Supersedes: EO 11602, June 29, 1971 EO 11752 Prevention, Control, and Abatement of Environmental Pollution at Federal Facilities ƒ Signed: December 17, 1973 ƒ Amended by: EO 12038, February 3, 1978 ƒ Revoked by: EO 12088, October 13, 1978 EO 11776 Continuing the President's Committee on Mental Retardation and Broadening Its Membership and Responsibilities ƒ Signed: March 28, 1974 ƒ Amended by: EO 12608, September 9, 1987 ƒ Supersedes: EO 11280, May 11, 1966 ƒ Committee continued by: EO 11827, January 4, 1975; EO 11948, December 20, 1976; EO 12110, December 28, 1978; EO 12258, December 31, 1980; EO 12399, December 31, 1982; EO 12489, September 28, 1984; EO 12534,

12

Bryan Hilliard and Richard M. Yon

ƒ

September 30, 1985; EO 12610, September 30, 1987; EO 12692, September 29, 1989; EO 12774, September 27, 1991; EO 12869, September 30, 1993; EO 12974, September 29, 1995 Superseded by: EO 12994, March 21, 1996

GERALD R. FORD (1974-1977) Selected Significant Activities As Vice-President, Gerald Ford directed the Nixon administration’s efforts regarding right to privacy legislation. As President, Ford signed into law the Privacy Act, which granted rights to individuals to control their personal information and gave citizens the right to view information the government had gathered about them. In his State of the Union address on January 19, 1976; President Ford stated, “We cannot realistically afford federally dictated national health insurance providing full coverage for all 215 million Americans. The experience of other countries raises questions about the quality as well as the cost of such plans.” In the same address, Ford called for budgetary consolidation of 16 health programs, including lead paint poisoning prevention, maternal and child health, and family planning, that did not require states to match the federal funds provided.8

Selected Executive Orders EO 11807 Occupational Safety and Health Programs for Federal Employees ƒ Signed: September 28, 1974 ƒ Supersedes: EO 11612, July 26, 1971 ƒ Federal Advisory Council on Occupational Safety and Health continued by: EO 11827, January 4, 1975; EO 11948, December 20, 1976; EO 12110, December 28, 1978 ƒ Revoked by: EO 12196, February 26, 1980 EO 11914 Nondiscrimination with Respect to the Handicapped in Federally Assisted Programs ƒ Signed: April 28, 1976 ƒ Revoked by: EO 12250, November 2, 1980

8

Stephen J. Williams and Paul R. Torrens, Introduction to Health Services, 4th edition (Albany, NY: Delmar, 1993), p. 100.

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JIMMY E. CARTER (1977-1981) Selected Significant Acitivites In 1977 the administration introduced a proposal to contain health care costs in hospitals. No legislation was adopted, but some hospitals tried for a year to contain costs. In 1978 President Carter issued 10 Principles for a “National Health Plan” designed to insure comprehensive health coverage for all Americans. No legislative action was ever taken. In 1978 the Ethics Advisory Board was established, and continued until 1980. On October 17, 1979, Carter signed the Department of Education Organization Act, which established the Department of Health and Human Services. Pub. L. 96-88. HHS was activated on May 4, 1980. In 1980 the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research was established,and it continued until 1983.

Selected Executive Orders EO 11973 President’s Commission on Mental Health ƒ Signed: February 17, 1977 ƒ Revoked by: EO 12110, December 28, 1978 EO 11991 Relating to Protection and Enhancement of Environmental Quality ƒ Signed: May 24, 1977 ƒ Amends: EO 11514, March 5, 1970 EO 12109 Federal Physicians Comparability Allowance ƒ Signed: December 28, 1978 EO 12133 Drug Policy Functions ƒ Signed: May 9, 1979 ƒ Revoked by: EO 12368, June 24, 1982 EO 12184 Relating to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research ƒ Signed: December 17, 1979 ƒ Revoked by: EO 12553, February 25, 1986 EO 12196 Occupational Safety and Health Programs for Federal Employees ƒ Signed: February 26, 1980 ƒ Revokes: EO 11807, September 28, 1974 ƒ Amended by: EO 12223, June 30, 1980; EO 12258, December 31, 1980; EO 12399, December 12, 1982; EO 12489, September 28, 1984; EO 12534, September 30, 1985; EO 12610, September 30, 1987; EO 12692, September 29, 1989; EO 12774, September 27, 1991; EO 12869, September 30, 1993; EO 12974, September 29, 1995; EO 13062, September 29, 1997; EO 12608, September 9, 1987; EO 13138, September 30, 1999; EO 13225, September 28, 2001 EO 12270 President's Council on Spinal Cord Injury ƒ Signed: January 15, 1981 ƒ Revoked by: EO 12553, February 25, 1986

14

Bryan Hilliard and Richard M. Yon EO 12286 Responses to Environmental Damage ƒ Signed: January 19, 1981 ƒ Revoked by: EO 12316, August 14, 1981

RONALD W. REAGAN (1981-1989) Selected Significant Activities In 1983 major revisions in the financing of Social Security were recommended, and adopted. These revisions included the Medicare prospective payment scheme on a diagnosticrelated group basis. In 1986 dramatic changes in Medicare and Medicaid occurred through the Consolidated Omnibus Budget Reconciliation Act. In addition to expanding Medicaid coverage for children and pregnant women, the Act prescribed federal penalties for hospitals that denied care to poor people in emergencies. The Emergency Medical Treatment and Active Labor Act was also part of COBRA. In 1987 President Reagan signed into law the McKinney Act, which provided, among other things, health care to homeless persons. See Pub. L. 100-77. In 1988 the Biomedical Ethics Advisory Committee was established, and it continued until 1989.

Selected Executive Orders EO 12316 Responses to Environmental Damage ƒ Signed: August 14, 1981 ƒ Revokes: EO 12286, January 19, 1981 ƒ Amended by: EO 12418, May 5, 1983 ƒ Revoked by: EO 12580, January 23, 1987 EO 12345 Physical Fitness and Sports ƒ Signed: February 2, 1982 ƒ Amends: EO 12258, December 31, 1980 ƒ Revokes: EO 11562, September 25, 1970; EO 11945, October 25, 1976; EO 12098, November 14, 1978 ƒ Amended by: EO 12399, December 31, 1982; EO 12489, September 28, 1984; EO 12534, September 30, 1985; EO 12539, December 3, 1985; EO 12610, September 30, 1987; EO 12692, September 29, 1989; EO 12634, October 11, 1989; EO 12709, April 4, 1990; EO 12774, September 27, 1991; EO 12869, September 30, 1993; EO 12974, September 29, 1995; EO 13062, September 29, 1997; EO 13138, September 30, 1999; EO 13225, September 28, 2001 ƒ Revoked by: EO 13265, June 6, 2002 EO 12358 Presidential Commission on Drunk Driving ƒ Signed: April 14, 1982 ƒ Amended by: EO 12376, August 5, 1982; EO 12415, April 5, 1983 ƒ Revoked by: EO 12553, February 25, 1986

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EO 12368 Drug Abuse Policy Functions ƒ Signed: June 24, 1982 ƒ Revokes: EO 12133, May 9, 1979 ƒ Amended by: EO 12590, March 26, 1987 EO 12450 Interagency Committee on Handicapped Employees ƒ Signed: December 9, 1983 ƒ Amends: EO 11830, January 9, 1975 EO 12452 Revised List of Quarantinable Communicable Diseases ƒ Signed: December 22, 1983 ƒ Revoked by: EO 13295, April 4, 2003 EO 12511 President's Child Safety Partnership ƒ Signed: April 29, 1985 EO 12564 Drug-Free Federal Workplace ƒ Signed: September 15, 1986 EO 12566 Safety Belt Use Requirements for Federal Employees ƒ Signed: September 26, 1986 ƒ Revoked by: EO 13043, April 16, 1997 EO 12590 National Drug Policy Board ƒ Signed: March 26, 1987 ƒ Amended by: EO 13284, January 23, 2003 EO 12591 Facilitating Access to Science and Technology ƒ Signed: April 10, 1987 ƒ Amended by: EO 12618, December 22, 1987 EO 12595 White House Conference for a Drug Free America ƒ Signed: May 5, 1987 EO 12601 Presidential Commission on the Human Immunodeficiency Virus Epidemic ƒ Signed: June 24, 1987 ƒ Amended by: EO 12603, July 16, 1987 ƒ Revoked by: EO 12692, September 29, 1989

GEORGE H.W. BUSH (1989-1993) Selected Significant Activities In 1990 Congress passed the Americans with Disabilities Act, perhaps the most extensive civil rights legislation since 1964. In the spring of 1992 President Bush proposed a “Comprehensive Health Reform Program” that included tax incentives and vouchers to meet the problem of the rising number of Americans without health coverage.

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Bryan Hilliard and Richard M. Yon

Selected Executive Orders EO 12696 President's Drug Advisory Council ƒ Signed: November 13, 1989 ƒ Amended by: EO 12756, March 18, 1991 EO 12700 President's Council of Advisors on Science and Technology ƒ Signed: January 19, 1990 ƒ Amended by: EO 12768, June 28, 1991; EO 12869, September 30, 1993 ƒ Revoked by: EO 12882, November 23, 1993 EO 12737 President's Commission on Environmental Quality ƒ Signed: December 12, 1990 ƒ Revoked by: EO 12852, June 29, 1993 ƒ EO 12777 Implementation of Section 311 of the Federal Water Pollution Control Act of October 18, 1972, as Amended, and the Oil Pollution Act of 1990 ƒ Signed: October 18, 1991 ƒ Amends: EO 12580, January 23, 1987 ƒ Amended by: EO 13286, February 28, 2003 ƒ Revokes: EO 11735, August 3, 1973; EO 12123, February 26, 1979; EO 12418, May 5, 1983 EO 12806 Establishment of a Fetal Tissue Bank ƒ Signed: May 19, 1992 ƒ Revoked by: Pub.L. 103-43 (107 Stat. 133)

WILLIAM JEFFERSON CLINTON (1993-2001) Selected Significant Activities On September 22, 1993, Clinton gave a speech before a joint session of Congress in which he outlined his plan for national health care reform.9 The Clintons tried, but failed, to develop and implement sweeping policy changes in the American health care system. In November of 1993 Clinton signed the Brady Handgun Violence Prevention Act. See Pub. L. 103-159, 107 Stat. 536. The Act provided, in part, that background checks be conducted on persons buying handguns. In 1997 the U.S. Supreme Court found certain provisions of the Act unconstitutional. In 1993 the Family Medical Leave Act was passed, requiring employers to provide 12 weeks of unpaid leave to employees for birth or to take care of a sick child or spouse. And, in September 1994, Senate Majority Leader George Mitchell declared the Clinton healthcare reform proposals (Health Security Act) dead.10 In 1996 concern over what was commonly referred to as “drive-through” deliveries led to passage of the Newborns’ and Mothers’ Protection Act. The legislation prohibited managed care plans from restricting inpatient hospital benefits to less than 48 hours. In 1996 Congress passed the Health 9

Marc Landy and Sidney M. Milkis, American Government: Balancing Democracy and Rights (New York: McGraw-Hill, 2004), p. 285. 10 Ibid.

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Insurance Portability and Accountability Act (HIPAA). Among the Act’s provisions is the requirement for private insurers to stop using pre-existing conditions as a reason to deny coverage.

Selected Executive Orders EO 12856 Federal Compliance with Right-to-Know Laws and Pollution Prevention Requirements ƒ Signed: August 3, 1993 ƒ Revoked by: EO 13148, April 21, 2000 EO 12859 Domestic Policy Council ƒ Signed: August 16, 1993 ƒ Note: The Domestic Policy Council and the National Economic Council compose the Office of Policy Development. These offices aid in the formulation, coordination, and implementation of domestic social and economic policies, including public health policies. The president may assign one or more members of the Domestic Policy Council to observe and act upon certain health issues.11 EO 12880 National Drug Control Program ƒ Signed: November 16, 1993 ƒ Amended by: EO 13008, June 3, 1996 EO 12881 Establishment of the National Science and Technology Council ƒ Signed: November 23, 1993 ƒ Amended by: EO 13284, January 23, 2003 EO 12882 President's Committee of Advisors on Science and Technology ƒ Signed: November 23, 1993 ƒ Revokes: EO 12700, January 19, 1990; EO 12768, June 28, 1991 ƒ Amended by: EO 12907, April 14, 1994; EO 12974, September 29, 1995; EO 13062, September 29, 1997; EO 13138, September 30, 1999 ƒ Revoked by: EO 13226, September 30, 2001 EO 12891 Advisory Committee on Human Radiation Experiments ƒ Signed: January 15, 1994 ƒ Revoked by: EO 13062, September 29, 1997 EO 12911 Seal for the Office of National Drug Control Policy ƒ Signed: April 25, 1994 EO 12961 Presidential Advisory Committee on Gulf War Veterans' Illnesses ƒ Signed: May 26, 1995 ƒ Continued by: EO 13034, January 30, 1997 EO 12963 Presidential Advisory Council on HIV/AIDS ƒ Signed: June 14, 1995 ƒ Amended by: EO 13009, June 14, 1996

11

Boufford, and Lee, p. 171.

18

Bryan Hilliard and Richard M. Yon EO 12975 Protection of Human Research Subjects and Creation of National Bioethics Advisory Commission. ƒ Signed: October 3, 1995 ƒ Amended by: EO 13018, September 16, 1996; EO 13046, May 16, 1997; EO 13137, September 15, 1999 ƒ On October 3, 2001, the NBAC ceased to exist. EO 12994 Continuing the President's Committee on Mental Retardation and Broadening Its Membership and Responsibilities ƒ Signed: March 21, 1996 ƒ Supersedes: EO 11776, March 28, 1974 ƒ Amended by: EO 13062, September 29, 1997; EO 13138, September 30, 1999; EO 13225, September 28, 2001 EO 13017 Advisory Commission on Consumer Protection and Quality in the Health Care Industry. ƒ Signed: September 5, 1996 ƒ Amended by: EO 13040, March 25, 1997; EO 13056, July 21, 1997 ƒ Note: The Commission produced two reports, Consumer Bill of Rights and Responsibilities: Report to the President of the United States and Quality First: Better Health Care for All Americans. The procedural recommendations of the Commission served as the foundation for most of the patient protection legislation introduced by the Democrats in the 105th and 106th Congresses.12 EO 13023 Amendments to EO 12992, Expanding and Changing the Name of the President's Council on Counter-Narcotics ƒ Signed: November 6, 1996 EO 13040 Advisory Commission on Consumer Protection and Quality in the Health Care Industry ƒ Signed: March 25, 1997 ƒ Amends: EO 13017, September 5, 1996 ƒ Note: EO 13040 is nullified by virtue of the Commission being abolished by EO 13138, September 30, 1999. EO 13045 Protection of Children from Environmental Health Risks and Safety Risks ƒ Signed: April 21, 1997 ƒ Revokes: EO 12606, September 2, 1987 ƒ Amended by: EO 13229, October 9, 2001; EO 13296, April 18, 2003 EO 13046 Extension of the National Bioethics Advisory Commission ƒ Signed: May 16, 1997 ƒ Amends: EO 12975, October 3, 1995 EO 13058 Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace ƒ Signed: August 9, 1997 EO 13100 President's Council on Food Safety ƒ Signed: August 25, 1998 ƒ Amended by: EO 13286, February 28, 2003

12

Eleanor Kinney, p. 194.

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EO 13124 Amending the Civil Service Rules Relating to Federal Employees with Psychiatric Disabilities ƒ Signed: June 4, 1999 EO 13137 Amendment to EO 12975, as Amended, National Bioethics Advisory Commission ƒ Signed: September 15, 1999 EO 13139 Improving Health Protection of Military Personnel Participating in Particular Military Operations ƒ Signed: September 30, 1999 ƒ See: Food and Drug Administration rule of May 25, 1999 (64 FR 54180) EO 13145 To Prohibit Discrimination in Federal Employment Based on Genetic Information ƒ Signed: February 8, 2000 EO 13147 White House Commission on Complementary and Alternative Medicine Policy ƒ Signed: March 7, 2000 ƒ Amended by: EO 13167, September 15, 2000 EO 13155 Access to HIV/AIDS Pharmaceuticals and Medical Technologies ƒ Signed: May 10, 2000 EO 13164 Requiring Federal Agencies to Establish Procedures to Facilitate the Provision of Reasonable Accommodation ƒ Signed: July 26, 2000 EO 13165 Creation of the White House Task Force on Drug Use in Sports and Authorization for the Director of the Office of National Drug Control Policy to Serve as the United States Government's Representative on the Board of the World Anti-Doping Agency ƒ Signed: August 9, 2000 ƒ Amended by: EO 13286, February 28, 2003 EO 13168 President's Commission on Improving Economic Opportunity in Communities Dependent on Tobacco Production while Protecting Public Health ƒ Signed: September 22, 2000 ƒ Revoked by: EO 13225, September 28, 2001 EO 13172 Amendment of EO 13078 (March 13, 1998), to Expand the Role of the National Task Force on Adults with Disabilities to Include a Focus on Youth ƒ Signed: October 25, 2000 EO 13181 To Protect the Privacy of Protected Health Information in Oversight Investigations ƒ Signed: December 20, 2000 EO 13193 Federal Leadership on Global Tobacco Control and Prevention ƒ Signed: January 18, 2001

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GEORGE W. BUSH (2001-PRESENT) Selected Significant Activities As early as 2000, Bush claimed that he opposed any type of national health care plan, saying he did not want the federal government making decisions for consumers or providers. On August 9, 2001, Bush gave a nationally televised speech in which he outlined the administration’s policy on federal funding of embryonic stem cell research. While on November 6, 2001, Attorney General John Ashcroft issued a memo to Asa Hutchinson, Chief Administrator of the Drug Enforcement Administration, asserting that physician assistance in a suicide is not a legitimate medical purpose under the Controlled Substances Act. Ashcroft’s directive was aimed at Oregon physicians who prescribe medication to assist their terminally ill patients in committing suicide. The DEA was instructed to review prescribing records of physicians, and to take administrative action against those physicians deemed to have violated the Controlled Substances Act. In 2002 a federal district court granted summary judgment for the state of Oregon, and issued a permanent injunction prohibiting Ashcroft, and the Bush Justice Department from implementing the directive.13 On September 27, 2002, the Bush administration announced that it would begin considering developing fetuses as “unborn children” for purposes of meeting requirements of the government funded health initiative known as the Children’s Health Insurance Program (CHIP). On December 13, 2002, President Bush put forth a plan making it mandatory for all military personnel in risky areas to have the smallpox vaccination and recommending that all health care workers take the vaccine. One week later the President was vaccinated against smallpox. On November 5, 2003, Bush signed legislation banning a certain type of abortion commonly referred to as “partial-birth” abortion. The legislation shares so much in common with a Nebraska law that the U.S. Supreme Court found unconstitutional in 2000. And, on November 22, 2003, the House, by a vote of 220-215, approved a $400 billion restructuring of Medicare. Three days later the controversial measure passed in the Senate by a 54-44 margin. The changes include more federal money for rural doctors and hospitals, allowing the creation of tax-sheltered saving accounts for medical expenses, and federal payment for outpatient prescription drugs. The proposed legislation represents the largest single change to Medicare since its inception in 1965.

Selected Executive Orders EO 13198 Agency Responsibilities with Respect to Faith-Based and Community Initiatives ƒ Signed: January 29, 2001 EO 13199 Establishment of White House Office of Faith-Based and Community Initiatives

ƒ 13

Signed: January 29, 2001

Ben A Rich, “Oregon v. Ashcroft: The Battle Over the Soul of Medicine,” Cambridge Quarterly of Health Care Ethics, 12, 3, (2003), 310-321.

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EO 13214 President's Task Force to Improve Health Care Delivery for Our Nation's Veterans ƒ Signed: May 28, 2001 EO 13217 Community-Based Alternatives for Individuals with Disabilities ƒ Signed: June 18, 2001 EO 13226 President's Council of Advisors on Science and Technology ƒ Signed: September 30, 2001 ƒ Amended by: EO 13305, May 28, 2003 EO 13229 Amendment to EO 13045, Extending the Task Force on Environmental Health Risks and Safety Risks to Children ƒ Signed: October 9, 2001 EO 13237 Creation of the President's Council on Bioethics ƒ Signed: November 28, 2001 EO 13263 President's New Freedom Commission on Mental Health ƒ Signed: April 29, 2002 EO 13265 President's Council on Physical Fitness and Sports ƒ Signed: June 6, 2002 ƒ Revokes: EO 12345, February 2, 1982 EO 13295 Revised List of Quarantinable Communicable Diseases ƒ Signed: April 4, 2003 EO 13296 Amendments to EO 13045, Protection of Children from Environmental Health Risks and Safety Risks ƒ Signed: April 18, 2003

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 23-33

ISBN: 1-60021-542-4 2008 Nova Science Publishers, Inc.

PRESIDENTS AND THE DEVELOPMENT OF MEDICARE IN THE UNITED STATES

Max J. Skidmore ABSTRACT When Lyndon B. Johnson signed the Medicare Act into law, it was the culmination of actions by numerous presidents, including the two Roosevelts, Truman, and Kennedy. Even Dwight Eisenhower’s approval of the addition of Disability Benefits to Social Security could be considered as part of the pattern, as could the actions of some subsequent presidents, including certain of Richard Nixon’s proposals. Ronald Reagan clearly had a strong influence also, but for the first time it was a negative presidential influence. Since LBJ, however, only Bill Clinton had the political courage to attempt to deal comprehensively with the manifold troubles in America’s health-care system that Theodore Roosevelt saw developing nearly a century ago—and he failed. On the whole, Medicare, with the notable exceptions of no prescription-drug coverage for outpatients and no provision for long-term care, operates well. The solution to projected cost increases is not “reform” of Medicare; rather it is reform of America’s entire, highly inefficient, health-care delivery system.

INTRODUCTION President Lyndon B. Johnson signed the Medicare Act into law at the Harry S. Truman Library and Museum in Independence, Missouri, on 30 July 1965. Former President Harry Truman was the honored guest. The following January, Harry and Bess Truman received the first Medicare registration cards issued, numbers one and two respectively.1 This was fitting. No president except perhaps for Johnson himself had exceeded Truman in his commitment to ensuring that health care was available to the population of the United States. In the 1940s, he had been the first president to propose providing health coverage through Social Security. Several other presidents before and since, however, in varying ways have also played key roles in Medicare’s development. 1

“Chronology, Harry S. Truman’s Life and Presidency: Postpresidential⎯1953-1972,” Harry S. Truman Library and Museum, http://www.trumanlibrary.org/truman-3.htm, p. 2.

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The roots of America’s Medicare system go far back in time, but there were several presidents who figured most prominently in the developments that led to the act that LBJ signed into law that day, or who contributed to the programs flowing from that act. They were Theodore Roosevelt, Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Johnson, Bill Clinton, and—in a negative sense—Ronald Reagan. In TR’s case, his influence came predominantly after his presidency. In Reagan’s case, it began long before he became president, and has had continuing repercussions. By the time of TR’s presidency⎯he was the first president to serve entirely in the twentieth century⎯some two decades had passed since the first modern comprehensive social insurance programs. These were in Germany, the best-known of which came under Chancellor Otto von Bismarck, whose pioneering efforts in 1883 included health coverage. Even Bismarck’s programs were based upon earlier Prussian legislation. The German model soon inspired similar programs throughout Europe, including the United Kingdom. In the United States, the idea for some sort of social insurance had been around for almost a century. In the winter of 1795-1796, Thomas Paine wrote a brief pamphlet, Agrarian Justice, published initially in a French edition in Paris; the first English edition was in 1797.2 Paine proposed a 10 percent tax on inheritances to create a national fund that would provide every person a cash payment upon becoming twenty-one, and also would provide every person an annual pension beginning at age fifty. It is noteworthy that he included both women and men. The United States did not adopt Social Security until 1935, and Medicare was not developed until three decades later. Although Paine’s program would not have included health care, even today—more than two centuries later—his proposal sounds radical. Paine’s concern was for the economic well-being of both women and men, both young and old. Even now, America is almost unique among industrial countries in having no general program to provide health care to the whole population, and it has little prospect for having one in the near future. Prevalent cultural attitudes, along with opposition from vested interests, have always made enacting any progressive program in the United States difficult. Regardless of party control of Congress, conservatives almost always dominate. True progressive reforms have been possible only during a few periods in American history, and generally these periods have been brief. One such period has gone largely unrecognized because it occurred during the Civil War, which, of course, overshadowed all other events and concerns. During the Lincoln administration Southern obstructionists withdrew from Congress, making progressive measures possible. In the first six months of 1862, Lincoln signed into law the Homestead Act, an act to establish a national currency, and an act to regulate banks; perhaps most radical of all, he signed “the first federal income tax in United States History.” Although Congress repealed the tax after the war, “it established what until then was considered a revolutionary principle: the idea of taxing rich people at a higher rate compared to the rate for people less well off.”3

2

The complete text of Paine’s Agrarian Justice is available on the website of the Social Security Administration: http://www.ssa.gov/history/tpaine3.html. 3 Steven R. Weisman, The Great Tax Wars, New York: Simon and Schuster, 2002, p. 33.

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The Progressive Period, the New Deal, and the Great Society essentially exhaust the list of periods of true progressive reforms. Such unusual periods present opportunity for progressive measures. There are two prerequisites for such periods to exist. First, there must be extraordinary conditions⎯a war, the emergence of corporate industrialism, a Great Depression, or some other unusual circumstance (9/11 could have been a prime example) that encourages national unity. Second the president must be a strong, resourceful, and visionary leader. The presidency is clearly the source of progressive reform. Medicare was no exception; it came about as an extension of the New Deal reform impulse, and required the brilliant legislative leadership of Lyndon Johnson. Medicare could not have come about during a period of normal politics, nor could it have come without an extraordinary president. Although the program is highly popular, it continues to face strong⎯if often covert⎯opposition. A comparison of the extent of health coverage in the United States with that in nearly all other industrial democracies indicates how slow the progress has been here. Despite the difficulties, the United States has made progress. Under the circumstances, that progress has been substantial. Certainly, many figures, private citizens as well as officials, have been involved. Presidents have not acted alone⎯others may deserve at least as much credit⎯but the commitment of a few presidents at a few key moments has been essential. Progress could not have occurred without them. Giving too much emphasis to these points is impossible.

THEODORE ROOSEVELT Theodore Roosevelt (TR) was a great progressive president, holding office at a time of a huge wave of reform. He was the first president who recognized the necessity for government regulation of huge concentrations of private economic power not only to regulate the economy, but also to preserve individual liberty. After his presidency, he developed an awareness of the need for governmental action to insure individual economic well being. On 31 August 1910, speaking in Osawatomie, Kansas nearly a year and a half after he left office, TR outlined the bold themes of his “New Nationalism.” Kathleen Dalton calls it “the most important speech of his political career.”4 Speaking before thirty thousand people, he sounded his “familiar themes,” but gave them “a more radical tone.” He thundered that the special interests must be driven out of politics, company directors must be held personally liable for the actions of their corporations, a graduated income tax and an inheritance tax must be levied in order to put “swollen fortunes” to public use, and the like. In 1912, failing to gain the Republican nomination again, TR embarked upon his famous “Bull Moose” bid for the presidency under the banner of the Progressive Party. On 6 August, he addressed the ecstatic delegates of the Progressive Convention, after accepting their nomination with his “Confession of Faith.” He spoke of the many reforms that he had previously sought, but this time “he went further and called for the creation of a full welfare

4

Kathleen Dalton, Theodore Roosevelt: A Strenuous Life, New York: Alfred A. Knopf, 2002, pp. 365-366.

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state by advocating social security insurance to cope with the ‘hazards of sickness accident, invalidism, involuntary unemployment, and old age. . . .’”5 Roosevelt, of course, failed to win his third, comeback, term. He did, however, run far ahead of the Republican incumbent, William Howard Taft, in both popular and electoral vote. His race paved the way for the victory of a Democrat, Woodrow Wilson, in a heavily Republican era. Reformers at first were dismayed at TR’s defeat, but soon discovered that in Wilson they had another champion of reform. Social Security and Medicare were some distance away, but for a time there was a flurry of activity.6 The American Association for Labor Legislation in 1912 formed a Committee on Social Insurance, which included considerations of health care. This resulted, in 1913 during the Wilson administration, in a national conference on social security that produced model social insurance legislation to be presented to state legislatures. In 1915, even the American Medical Association expressed some interest in a government-supported health program. Several states did consider the proposed legislation, but all rejected it. By 1918, serious opposition had arisen within the AMA. Quickly, the AMA transformed itself into the most implacable foe of government health insurance of any special-interest group in the country. Insurance companies and pharmaceutical houses were nearly as strong in their opposition. As the prominent scholar of health politics, Odin W. Anderson, put it, the AALL leaders naively assumed “that a reform which they thought should be deemed good by everyone would triumph on its own merits.”7 They were mistaken. TR remained active in advocating reform, but he was out of office, and his support could no longer be decisive. Wilson’s more cautious proposals did not attempt to mobilize support for health care. When TR died in January of 1919, the country lost its most articulate spokesman from the public sector⎯of course he was a private citizen, but, as a former president he retained some of the influence, if not the power, of a public official. Until Dalton’s excellent study, writers on the period⎯with a few notable exceptions⎯tended to overlook Roosevelt’s continuing advocacy of progressive reform, treating his postpresidential years as though they involved little more than bitter attacks upon his antagonist, Woodrow Wilson. Dalton has helped bring perspective to studies of TR, and therefore, to the development of social insurance and government programs for health care in the United States. There were a number of studies advocating social insurance during the next decade or so, but they tended to deal largely with income maintenance. The sweeping Republican victory in 1920 set the tone. The triumphant winner for the first time in American history received 60 percent of the popular vote. This was no Theodore Roosevelt; no Progressive Republican. This was Warren G. Harding, who called for a return to “normalcy.” Harding, a conservative with a whiggish view of the presidency, vowed to leave policy formulation to Congress. He died in office in 1923 to be succeeded by Vice President Calvin Coolidge, who as one recent study observed, “raised inactivity to an art.”8 5

John Allen Gable, The Bull Moose Years: Theodore Roosevelt and the Progressive Era, Port Washington, NY: Kennikat Press, 1978, pp. 81-83. 6 Odin W. Anderson, “Compulsory Medical Care Insurance, 1910-1950,” Annals of the American Academy of Political and Social Science, 273 (1951), pp. 106-111. 7 Ibid., p. 110. 8 Sidney M. Milkis and Michael Nelson, The American Presidency, 4th ed., Washington: CQ Press, 2003, p. 258.

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Coolidge was passive, but popular. In 1924 he won his own term handily, becoming the second vice president who succeeded a fallen president to win nomination and election in his own right. Ironically, the first one to do so could hardly have presented a greater contrast to the indolent Coolidge⎯it was Theodore Roosevelt. Coolidge declined to run in 1928, and again a conservative Republican won easily. The new president, Herbert Hoover, was far from passive. Nevertheless, he adhered to a rigid ideology that prevented him from being effective as president. He believed in government activity, but in general only to exhort private effort. Any assistance directly to individual citizens, even unemployment benefits, would be “socialism” and lead to government despotism; according to Hoover. Many later politicians have adopted his theme in spite of the fact that it is historical nonsense. No dictatorship has ever resulted because of social welfare measures, but that has not prevented continuing assertions that it does. As for Hoover, he proved completely unable to deal with the Great Depression that hit the country shortly after he took office.

FRANKLIN D. ROOSEVELT Conditions had become so difficult under Hoover that Franklin D. Roosevelt won overwhelmingly in 1932. Hoover had not caused the Depression, but he received the blame. Not only was he in office, and the buck stopped there, but he gave no evidence of being able to cope with the crisis. His cold demeanor mistakenly gave the impression that he had no concern for the plight of the people. Groups of tarpaper shacks and piano-crate boxes served as makeshift shelters thrown together throughout the country by the homeless. They became known as “Hoovervilles.” Under such circumstances it would be possible once again to consider progressive measures if the right kind of leadership emerged. With FDR, it did. Among the many programs that Roosevelt achieved, the most outstanding⎯and without doubt the greatest break with the anti-governmental past⎯was the Social Security System. The 1935 Act provided most notably for unemployment, and old-age benefits. Amendments in 1939 expanded the system to include benefits for spouses, and for survivors of deceased wageearners. The missing benefit, of course, was health care. The President’s Committee on Economic Security studied health care, but included only a brief mention of the subject in its report, in spite of its original charge to consider health measures as an overall part of economic security. The Committee’s executive director, Edwin Witte, noted that medical leaders were fearful that the administration was attempting to include governmental health insurance. FDR did not push the issue. He was interested above all in obtaining passage of Social Security. Secretary of Labor, Frances Perkins said that the AMA’s opposition was so strong that any inclusion of health benefits “could have prevented passage of the entire Social Security Bill.”9 In fact, as soon as it became known that FDR was appointing a Committee on Economic Security, the White

9

Max J. Skidmore, Medicare and the Rhetoric of Reconciliation, Tuscaloosa: University of Alabama Press, pp. 6667.

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House had been deluged with telegrams, letters, and telephone calls demanding appointment of a physician known to be an outspoken critic of any government plan. FDR, therefore, backed off from any effort to include health care. Objectively considered, it is difficult to see that inclusion of health benefits would have been any more radical than the inclusion of unemployment and old-age benefits. The difference was the nature of the special interests. They were much more organized to resist health benefits than any other program. Although FDR did not call for health benefits, he did secure the first true comprehensive social insurance program in the United States, therefore paving the way for the ultimate addition of health care as a benefit.

HARRY S. TRUMAN Although the idea was not unique to Truman, he was the first president to propose formally that the Social Security system be expanded to include health care. On May 19, 1947, he requested from Congress an extensive program of public-health services with special attention to mothers and children; additional federal support for medical education and research; funds for additional hospitals and physicians; and “an insurance program that would allow people to pay their medical costs, and to make up for their loss of earnings during times of illness. The reaction from certain quarters was ferocious. Insurance and pharmaceutical companies joined with the American Medical Association in conducting an intensive and expensive campaign against Truman’s ‘socialized medicine’ program.”10 He pushed on, regardless. Congressional resistance to a presidential legislative initiative was nothing unusual. “What was novel was a President who, when repeatedly rebuffed, refused to change his tactics.” The radical nature of his proposal also was novel. He proposed compulsory national health insurance to be paid for through payroll deductions. “All citizens would receive medical and hospital service irrespective of their ability to pay.”11 This was far more comprehensive than anything even proposed, not to mention adopted, until the Clinton presidency. The United States remains one of the few industrial countries having nothing resembling Truman’s proposals of more than a half-century ago. In a message to Congress the following year, on January 7, 1948, Truman again called for a sweeping program of various progressive measures, including national health insurance. “The Republicans, as anticipated, did not like it at all, any more than did the southern Democrats.”12 In fact, later that year he had to veto a Republican measure that would have taken Social Security benefits away from some three-quarters of a million people. On June 14th he blasted their attempt in a hard-hitting speech to the Greater Los Angeles Press Club. He said he refused “to let them get away with tearing up Social Security,” and pointed out that this had been a response to his request for expansion of Social Security’s base.13 Throughout the 1940s a series of “Wagner-Murray-Dingell” bills (Senators Wagner and Murray, and Representative Dingell were the sponsors) called for health care reform. Truman 10

Donald R. McCoy, The Presidency of Harry S. Truman, Lawrence: University Press of Kansas, 1984, p. 105. David McCullough, Truman, New York: Simon and Schuster, 1992, pp. 473-474. 12 Ibid., p. 586. 13 Max J. Skidmore, Social Security and its Enemies, Boulder, CO: Westview Press, 1999, pp. 116-117. 11

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supported the 1945 proposal, the first under his presidency. His 1947 proposal was another. His last comprehensive proposal came in 1949, and was similar to the Wagner-MurrayDingell Bill of 1947. This proposal was based on a massive report that Truman had commissioned, The Nation’s Health: A Ten Year Program, by Oscar Ewing (head of the Federal Security Agency). Truman earlier had established a Commission on the Health Needs of the Nation, which produced the Ewing Report. In his 1949 State-of-the-Union address, Truman pointed to the health needs of Americans, and said, “we need⎯and we must have without further delay⎯a system of prepaid medical insurance which will enable every American to afford good medical care.”14 The AMA flooded the country with propaganda opposing any government insurance plan.15 Working through a National Physicians Committee for the Extension of Medical Service, it inundated patients with pamphlets in physicians’ waiting rooms, included leaflets with their bills, and launched a massive advertising campaign. Threaded throughout was the theme that government support for health-care bills was “socialism,” or even worse, “communism.” Often the material referred specifically to the Soviet Union. Partly because of such tactics, and partly because the country simply was tired of reform and war; Truman was generally much less successful with his domestic agenda, the “Fair Deal,” than he was with his strong foreign policy. Through the 1950s, the propaganda battle subsided. The Eisenhower administration was not inclined be innovative with regard to progressive legislation, and Eisenhower himself was careful to avoid any hint of “socialism.” Nevertheless, he fully accepted the major outlines of the New Deal, and made no attempt to reverse its progress. In fact, during the Eisenhower administration the Social Security system not only expanded, and Ike pointed with pride to that expansion, but President Eisenhower signed into law one of the greatest additions to that system in its history: disability benefits. However, Eisenhower took no steps to develop a Medicare-type program. Representative Aime Forand did introduce a series of bills relating to health-care benefits, but they received no administration support, and died in Congress. Although Progressives could not have recognized it at the time, there was a cloud on the horizon. A former film actor had become a spokesman for the General Electric Corp., and his political talks around the country at company gatherings were attracting the attention of antigovernmental activists. Slowly, beneath the general awareness of the public, they began to coalesce around his leadership. His name was Ronald Reagan; he gave his talk thousands of times. He called it simply, “The Speech.”16 Staples of “The Speech” were, among other things, the evils of communism, and of Big Government assertions, more than four decades ago, that Social Security was a failure, and was “bankrupt,” and fierce attacks on government health insurance.

14

Ibid., p. 52; pp. 117-118. See ibid., pp. 53-55; See also Skidmore, Medicare, passim. 16 See Kurt Ritter, “Ronald Reagan and ‘The Speech,’: The Rhetoric of Public Relations Politics,” Western Speech, 32:1 (Winter 1968); reprinted in Max J. Skidmore, Word Politics: Essays on Language and Politics, Palo Alto: Freel and Associates, 1972, pp. 110-118. 15

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JOHN F. KENNEDY Although the Forand Bills stood no chance of becoming law during the Eisenhower administration, the AMA attacked them fiercely. They were a foot-in-the-door strategy, said the Association’s press releases that would lead to socialized medicine. The chances for such legislation increased greatly when John F. Kennedy assumed the presidency. So did the AMA attacks. Kennedy’s greatest strength as president was symbolic. He projected an image of youth, vigor, and good will, not only to Americans, but around the world. He pledged to get the country moving again, and firm support for health care was a key part of his domestic agenda. Legislative leadership was not Kennedy’s greatest talent, but he was genuinely committed to health care for the aged through Social Security. In contrast to some other parts of his “New Frontier,” such as civil rights, his efforts on behalf of what came to be called Medicare were there from the beginning. He put the full weight of the presidency behind the new AndersonKing Bill that Senator Clinton Anderson and Representative Cecil King were sponsoring. Kennedy appeared on national television, speaking from Madison Square Garden on May 20, 1962 at a rally to urge support for Medicare. The administration scheduled 42 such rallies around the country. Physicians’ groups in numerous locations threatened boycotts. The AMA bombarded the airwaves with anti-Medicare advertisements, it enlisted Reagan’s covert assistance to encourage anti-Medicare mail to Congress⎯the AMA’s so-called “Operation Coffeecup” featuring a recording, “Ronald Reagan Speaks Out Against Socialized Medicine”; it placed an anti-Medicare article in the then very popular Reader’s Digest; and it urged physicians who had members of Congress as patients to lobby them to oppose Medicare.17 Both sides blanketed the country with advertisements in every conceivable medium. It was one of the most intensive public-relations campaigns in history, and Medicare failed.

LYNDON B. JOHNSON After Kennedy’s tragic assassination on November 22, 1963, Vice President Johnson stepped into the presidency. President Johnson, a legislative genius, clearly one of the most skilled politicians in American history. This was a rare opportunity for progressive legislation in the United States to once again emerge briefly. Johnson moved quickly to conduct a “War on Poverty” as part of his “Great Society.” LBJ ran for his own term in 1964, and won the greatest popular-vote majority in American history. He is the only president ever to achieve 61 percent of the popular vote, and only the fourth to win his own term after stepping from the vice presidency into a presidential vacancy. The Great Society brought new programs one after another. They included, among others; Head Start, the Work-Study Program, Federal Aid to Education, the Civil Rights Act of 1964, the Voting Rights Act of 1965, environmental protections, assistance to the arts and humanities, and, most relevant here, Medicare. His legislative accomplishments rivaled those of Woodrow Wilson and Franklin D. Roosevelt. 17

See Skidmore, Medicare, chapters IV-VI.

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Irony abounded in his presidency. Physicians discovered quickly that Medicare worked significantly to their advantage, as they began to receive payment for many services to indigent patients that would previously have been written off. The AMA in 1939 had said in its official journal JAMA (The Journal of the American Medical Association), that “indeed, all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism.” The author was JAMA’s editor and prominent AMA spokesman, Morris Fishbein, M.D. Immediately after Medicare’s passage, the AMA leadership had even considered making it mandatory for its members to refuse to treat Medicare patients.”18 Soon, however, attitudes changed. Dr. Fishbein, who for three decades had been identified as the AMA’s most outspoken opponent of Medicare, railing against “medical soviets” and “peasant medicine,” conceded that the AMA should have cooperated with the government to help shape the program, rather than opposing it rigidly. On October 29, 1965, he even said publicly that “as conditions change, we must adapt to the changes.” He expressed support for federal programs, including Medicare. “When conditions become so severe they can no longer be handled by private initiative,” he said, “the government must step in.”19 It was a statement that could have come from TR, FDR, Truman, Kennedy, or LBJ.

RONALD REAGAN A long chain of presidents from both parties; FDR, Truman, Eisenhower, Kennedy, LBJ, Nixon, Ford, and Carter, had accepted the basic outlines of the New Deal, and had recognized the need for social insurance in the complex modern world. Reagan, who took office on January 20, 1981 was the first to reject the modern approach to politics and to attempt to turn his back on what had become traditional American government. He had a long record of opposition to Medicare, and even to Social Security. He came to office announcing that government was not the solution to the problem, government was the problem. By the time he became president, Reagan had been Governor of California for two terms. Prior to that, he had attracted national attention by giving on national television a stirring rendition of “The Speech” on behalf of Senator Barry Goldwater’s doomed presidential candidacy in 1964. Even before that, in 1961, he had been the nucleus of the AMA’s clandestine campaign, “Operation Coffeecup,” to encourage individually handwritten letters to members of the House and Senate to opposed Medicare. The public-relations campaign was brilliant. The AMA sent copies of “Ronald Reagan Speaks Out Against Socialized Medicine” to the president of every women’s auxiliary to the county medical society in the country, members of which were all physicians’ wives. They were instructed to “put on the coffeepot,” play Reagan’s record to their friends, and then urge each one to write on provided stationery. The text was Reagan’s familiar, “Speech.” He no doubt terrified many of his listeners with his conclusion, telling them that if they did not 18 19

Quotation Ibid., p. 131; see also p. 186, n9. Quoted ibid., pp. 145-146.

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prevent the passage of Medicare, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”20 When Reagan debated President Carter during the 1980 campaign, Carter said that Reagan had begun his career attacking the idea of Medicare. Reagan responded with his famous line, “there you go again,” and denied that he opposed the principle, merely that he had favored another program that Congress was then considering.21 Carter had been absolutely right; Congress was considering no such program, and Reagan opposed any governmental assistance except to the very poor, and then under the control of states. The audience laughter, though, threw Carter off his stride, and Reagan’s untruthful statement stood. There were many factors that contributed to his election, and most people credit the debate as a significant one. Once in office, Reagan moved to cut Social Security. The firestorm of protest caused him to back away, but in a major way he succeeded. He left a legacy that has made it possible, if done discreetly (or deviously), to oppose Social Security and Medicare, and still survive politically. One can call for vouchers to replace Medicare, for example. Beneficiaries then would use the vouchers to purchase private coverage. Apart from being a massive subsidy to the woefully inefficient private insurance mechanisms that have brought this country such maldistribution of health coverage, vouchers would provide no specific benefit, no guarantee of coverage, and no guarantee that the beneficiary would not face burdensome additional charges. It would, though, eliminate a government program. This is ideology, not economics.

WILLIAM JEFFERSON CLINTON Although Richard Nixon had proposed expansion of health coverage by encouraging employers to provide insurance, Bill Clinton was the first president since LBJ to turn his attention to the need for comprehensive health care. He was new in office, and inexperienced, and that handicapped his efforts. In view of the other accomplishments that he did manage to achieve under highly adverse conditions; a budget with a tax increase for which no Republican would vote but which was a major factor in eliminating the deficit, for example, he may have had the legislative skills necessary to secure passage. What he did not have was the right combination of circumstances. Ideologues worked with the special interests to make hysterical and inaccurate charges. Clinton, they said, was attempting a “government take-over of health care.” Even more nonsensically they said that he was attempting to “socialize one-seventh of the U. S. economy.” Undoubtedly, the Clinton plan was overly complex. No serious and well-informed observer, though could honestly have seen it or continue to portray it as “socialism.” At its simplest, the Clinton proposal required employers to provide health insurance through private companies to their employees.

20 21

For the full text, see Skidmore, Social Security, Appendix. See Max J. Skidmore, “Ronald Reagan and ‘Operation Coffeecup:’ A Hidden Episode in American Political History,” Journal of American Culture, 12:3 (Fall 1989).

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CONCLUSION After TR’s whirlwind, but failed, Bull Moose campaign, more than two decades passed before his distant cousin, Franklin D. Roosevelt, came to power, and brought his New Deal. Only then was it possible to secure any of the programs that TR had suggested, and not until more than half a century after TR, with Lyndon Johnson’s Great Society, was Medicare possible to achieve. Even then, Medicare benefits were limited to the elderly. Now that another three decades have passed, these programs that have become fundamental to the American way of life again are under fierce attack from opponents; opponents who draw their policy proposals from the nineteenth century. One such opponent today occupies the presidency. His calls for privatization or vouchers, coming as they do from the President of the United States, can only undermine public confidence, regardless of the fundamental soundness of the programs involved. The lack in Washington today of such courage as TR displayed over 90 years ago should give pause to anyone who might still believe that progress is inevitable. FDR, Truman, Kennedy, and LBJ helped achieve much of TR’s dream, as did Dwight Eisenhower, and even Richard Nixon. Since LBJ, however, no president except Bill Clinton has sought to provide a comprehensive solution to the problems with health-care delivery that TR saw developing nearly a century ago⎯and Clinton, of course, failed. To be fair, Nixon did seek to expand health coverage but not in a comprehensive manner. Troubles exist in the Medicare system, but on the whole this system operates well. The solution that will prevent burdensome costs to the public in years to come, if projections of health cost increases are accurate,is not to reform Medicare. Rather, the solution is to reform the health-care delivery system in the United States. This can only occur when proper conditions exist, and when there is vigorous presidential leadership that also is sound and thoughtful. Currently, America’s health-care delivery costs far more than that in any other country, and simultaneously it fails to provide the universal coverage⎯generally high-quality coverage, one might add⎯found in other industrial nations. No great degree of perception is needed to recognize that the current health-care delivery system is flawed; nor is great discernment required to recognize that privatization is not the answer to America’s current health-care crisis. Perhaps we should remember that private health-care delivery systems led to the unsatisfactory situation that exists today.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 35-50

ISBN: 1-60021-542-4 2008 Nova Science Publishers, Inc.

PRESIDENT BUSH AND STEM CELL POLICY: THE POLITICS OF POLICY MAKING

Kant Patel and Mark Rushefsky ABSTRACT This article examines the politics and ethics surrounding President Bush’s stem cell policy announced to the nation in August 2001. The article discusses arguments for and against federal funding for stem cell research, the policy alternatives available, and the policy option he selected. Ethical, scientific, and political implications of Bush’s decision are examined, and we argue that his decision is ethically inconsistent, will harm scientific progress on whatever potential benefits stem cell research holds, and will prove politically unsatisfactory. The article concludes that President Bush’s stem cell policy decision was founded more on political considerations than sound ethical principles.

INTRODUCTION Embryonic stem cell research has generated a significant amount of controversy, and debate among its supporters, and opponents. This controversy becomes intense over the question of whether the federal government should fund such research. At the center of this debate is a complex set of ethical, political, and legal issues. Supporters of embryonic stem cell research argue that such research may help cure diseases such as Parkinson’s and diabetes, and it offers scientists an opportunity to advance their understanding of genetic disorders. In addition, the research will lead to interventions whereby damaged tissues are replaced, and transplanted organs are created from a patient’s own cells, solving the problem of tissue and organ rejection.1 The opposition to this research is based on the argument that deriving embryonic stem cells leads to the destruction of a human embryo, which is equivalent to murder. Opponents further maintain that the human embryo deserves the same respect and rights as a fully developed human being, thus creating and then destroying human embryos for the purpose of

1

Bert Vogelstein, Bruce Alberts, and Kenneth Shine, “Please do not call it Cloning,” Science 295 (February 15, 2002): 1237. Also see Steve Mitchell, “Congress Grapples over Cloning Issue,” United Press International (June 30, 2003).

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benefiting another is unethical.2 Finally, critics note that research on adult stem cells hold the same scientific promise without the attendant ethical problems. The debate over embryonic stem cell research is invariably connected to the question of whether scientists should be allowed to clone human embryos for research purposes (therapeutic cloning), and for reproductive purposes (reproductive cloning). Although a strong consensus among policy makers, and the general public, against reproductive cloning exists, a great deal of disagreement prevails over the issue of therapeutic cloning.3 As a result, despite many efforts, Congress during the late 1990s failed to formulate a well-crafted cloning policy.4 However, several presidents have tried to formulate a policy with respect to whether federal funds can be used for embryonic stem cell research. President George W. Bush in August 2001 declared that federal funding for embryonic stem cell research would be limited to stem cell lines already in existence prior to August 9, 2001. The purpose here is to examine the politics of policy making regarding stem cell research and how politics shaped President Bush’s policy making on this issue. In the process, the political, ethical and legal arguments surrounding embryonic stem cell research is presented as well as the ethical, scientific, and political consequences of President Bush’s policy. As background, a brief history of policy development in this area during the late 1980s and 1990s is presented.

POLICY DEVELOPMENTS The use of embryonic tissue for research became controversial after the 1973 U.S. Supreme Court decision in Roe v. Wade legalizing abortion. Since the 1980s, the federal government has restricted the use of federal funds for research in which fetuses and embryos could be harmed or destroyed. In March 988, Assistant Secretary of Health Dr. Robert E. Windom declared a moratorium on federal support for fetal tissue transplantation research. He asked the National Institutes of Health (NIH) to establish an advisory panel to examine the issue.5 The NIH Human Fetal Tissue Transplantation Research Panel voted 19-2 in favor of government funding. After the transition from the Reagan administration to George H. W. Bush, the Secretary of the Department of Health and Human Services (DHHS), Louis Sullivan, in 1989, extended the moratorium on federal funding based on the view that lifting the moratorium would lead to an increase in abortions, a view held by a minority of the panel members. In 1990, Congress voted to override the moratorium; however, President Bush vetoed the legislation.

2

Peter Berkowitz, “The Pathos of the Kass Report,” Policy Review (October-November 2002): 71-78. Steve Mitchell, “Analysis: Research Results Support Cloning,” United Press International (March 4, 2003); Arlene J. Klotzko, “Take Therapeutic Cloning Forward,” Scientist 16 (July 22, 2002): 11-12; Peter Berkowitz, The Pathos of the Kass Report,” Policy Review (October-November 2002): 71-78; Richard T. Hull, and Tom Flynn, “Defending Cloning and Stem Cell Research against Faith-Based Curbs,” Free Inquiry 23 (Winter 2002): 27. 4 Andrea Bonnicksen, Crafting a Cloning Policy: From Dolly to Stem Cells (Washington, D.C.: Georgetown University Press, 2002); William Kristol, and Eric Cohen, eds., The Future is Now: America Confronts the New Genetics (New York: Rowman & Littlefield Publishers, Inc., 2002). 5 Alexander M. Capron, “Stem Cells: Ethics, Law, and Politics,” Biotechnology Law Report 20 (October 2001): 678-699. 3

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In November 1992, Bill Clinton was elected president, and in January 1993, he directed the incoming Secretary of DHHS to lift the moratorium. In March 1993, the NIH published new guidelines based on the 1988 advisory panel’s recommended safeguards for permissible research. Congress enacted these guidelines into law in the NIH Revitalization Act of 1993. Safeguards provided under the law include full disclosure of information, and voluntary, informed consent of donors. Furthermore, the law prohibits researchers from paying for fetal tissue, thus removing any financial incentives to women for conceiving a fetus and aborting it for financial gain.6 The 1994 NIH Human Embryo Research Panel recommended allowing the use of embryos remaining from in vitro fertilization (IVF) for research on the condition that the embryos were donated for research with the informed consent of the donors. The panel also recommended, with dissent that under some circumstances researchers should be allowed to create human embryos using IVF with the intent to use them solely for research.7 However, President Clinton, facing considerable opposition, issued a directive that no federal funds were to be used to create human embryos for research. In 1996, Congress enacted the Dickey Amendment to DHHS’s FY 1996 appropriation prohibiting federal funding for research in which human embryos are created through any means (including IVF and cloning), or are destroyed or discarded for research purposes. Thus, beginning in 1996, federal law banned federal funding of human embryo research. In November 1998, a genetics company, Geron, announced that it had extracted, for the first time, stem cells from human embryos. In response, President Clinton asked the National Bioethics Advisory Commission (NBAC) to review issues related to human stem cell research. In September 1999, the NBAC issued its report titled Ethical Issues in Stem Cell Research.8 The report recommended federal funding for embryonic stem cell research with discarded embryos. The report also advocated implementation of safeguards against abuses of embryonic stem cell research. Major safeguards recommended included requiring informed and voluntary consent by the donor, prohibiting designated or restricted donations, forbidding the selling of embryos, using the minimum number of IVF embryos to derive embryonic stem cells, and notifying researchers and recipients of the sources of embryonic stem cells.9 In 1999, DHHS concluded that the 1996 congressional ban on funding research involving human embryos did not extend to stem cell research because stem cells are not embryos and do not have the potential to develop into a fetus or a person. Pursuant to this, the NIH issued guidelines for federally funded stem cell research following guidelines recommended by the NBAC in its report. Under the guidelines, federal funds could not be used to derive stem cells from embryos, and federal funds could be used only for research involving stem cells produced through privately funded initiatives. 10 Furthermore, the stem cells could only have been derived from spare or left over human embryos that were created for fertility treatment. NIH guidelines also required informed consent of the donors, and stipulated that donors could not derive any financial benefits from their decision to donate. 6

NIH Revitalization Act of 1993. Public Law No. 103-43. Ronald M. Green, “Stopping Embryo Research,” Health Matrix 9 (1999): 235, 238. 8 National Bioethics Advisory Commission, Ethical Issues in Human Stem Cell Research: Report and Recommendations. Volume 1 (Rockville, MD: National Bioethics Advisory Commission, 1999). 9 Ibid. 10 Jeffrey P. Kahn, “Stem Cells and a New Brain Drain,” (July 1, 2001): On-line at [http://www.cnn.com/health]. 7

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Federal funding of embryonic stem cell research became a major issue in the 2000 presidential campaign. During the campaign, Republican candidate George W. Bush indicated that he would review, and likely reverse the Clinton administration’s policy on stem cell research. In fact, his spokesperson indicated that candidate Bush opposed federal funding for research that requires embryos to be discarded or destroyed.11 Political and religious conservatives, including the Catholic Church, supported a ban on federal funding, and Bush was trying hard to win the Catholic vote. Upon assuming the presidency, President Bush was confronted with the task of formulating policy on the question of federal funding of embryonic stem cell research. A coalition of medical and scientific organizations along with notable Nobel laureates wrote a letter to President Bush urging him to retain the existing NIH guidelines, arguing against regulations that would prohibit federal funding for embryonic stem cell research.12

POLICY ENVIRONMENT As with most disputes and concerns in the policy arena, special interest groups adopted various positions on the issue. The split among Republicans is especially noteworthy. We begin by identifying supporters of the policy, and the arguments they employ. Next, we identify opponents of federal funding for stem cell research, and their arguments. Finally, we take note of the division within the Republican Party itself. Sometimes groups form large associations.13 For example, labor unions have a large association group, the AFL-CIO. In the stem cell case, the Coalition for the Advancement of Medical Research (CAMR) is just such an organization. The coalition’s purpose, according to its web site (www.camradvocacy.org/fastaction), is to foster research in regenerative medicine, which includes stem cell research, or, as they call it, somatic nuclear cell transfer. CAMR is composed of universities, scientific societies, patient organizations, and individuals with disorders that might be helped by stem cell research. This coalition is comprised of some seventy-five separate organizations. One set of groups within the coalition is scientifically based groups, such as professional societies and academic organizations. Members in this category include the American Medical Association (AMA) and the Federation of American Societies for Experimental Biology (FASEB). Corporations, such as Geron Corporation (a major research company working in this area), may also support stem cell research. The Biotechnology Industry Organization is an association of companies with an interest in stem cell research. Patient groups include the Christopher Reeve Paralysis Foundation and the Michael J. Fox Foundation for Parkinson’s Research. Pro-choice groups, such as NARAL, also support such research. These groups oppose any restrictions on reproductive technology.

11

Arthur Allen, “Will Thompson, Bush Clash over Human Embryo Research?” (December 29, 2000): On-line at [http://www.salon.com]; Also see Jessica Reaves, “Stem Cells: When Politics and Science Collide,” (August 24, 2000): On-line at [http://www. cnn.com/health]. 12 Kathi Hanna, “Stem Cell Politics: Difficult Choices for White House and Congress,” Hasting Center Report 31 (July 2001): 9. 13 The classic statement of this can be found in David B. Truman, The Governmental Process: Political Interests and Public Opinion (New York, Knopf, 1951).

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The arguments in favor of funding stem cell research are fairly straightforward. Such research may lead to treatment of diseases such as diabetes, Parkinson’s, spinal cord damage, and Alzheimer’s disease, through slowing its progression. Stem cell research, including therapeutic cloning (producing a new embryo from a clone, and then extracting stem cells), could alleviate the nationwide shortage of donor organs, and successfully address the problem of donor organ rejection. One commentator, Arlene Judith Klotzko, argues that this research will allow us to become “masters of our fate.”14 That is, humans as a group would no longer be subject to, or limited by the vagaries of natural reproduction. Supporters of stem cell research also argue that their view is ethical. In this perspective, the proper ethical position is to try to reduce human suffering, thus limiting such research condemns those with a debilitating or life threatening disease to a lifetime of suffering. The status of the embryo is also relevant in this debate. Supporters argue that as a result of in vitro fertilization, thousands of frozen embryos are being kept but will never be used. At some point the embryos will be destroyed anyway. Therefore, supporters maintain, these embryos should be made available for stem cell research. A related point is that supporters of this research do not view embryos as human, though they admit that embryos are potentially human. To these supporters, depending on their view, an embryo is not human unless implanted in a female. To others, the embryo must be at least fourteen days old, and have demonstrated some specialization of cells to be considered human. Opponents of stem cell research are vocal as well. A major opponent is an organization called Do No Harm: The Coalition of Americans for Research Ethics whose website can be found at www.stemcellresearch.org. The coalition’s founding statement, issued July 1, 1999, opposed embryonic stem cell research on the following grounds: 1) that it violates state, national and international law; 2) that it is unethical; and 3) that it is unnecessary. We will consider these arguments below. The eight founding members are all academics, one of whom, Frank Young, is a former commissioner of the Food and Drug Administration. Another major opponent is the Catholic Church. The Church’s insistence that humans have a moral obligation to follow the dictates of natural law is well known. In the United States, the most important Catholic organization is the United States Conference of Catholic Bishops. In a July 18, 2001, statement before a Senate Appropriations subcommittee, Richard M. Doerflinger, the Associate Director for Policy Development at the Conference’s Secretariat for Pro-Life Activities, testified against funding stem cell research, or, as he put it, “forcing U.S. taxpayers to subsidize research that relies on deliberate destruction of human embryos for their stem cells.”15 This view is shared by the Do No Harm coalition. Other major opponents to federal funding include The National Right to Life Committee, Focus on the Family, and the American Family Association. As noted, three basic reasons that these groups oppose stem cell research, and funding for such research are given. The first claim is that such research is illegal. The Do No Harm

14 15

Arlene Judith Klotzko, “Take Therapeutic Cloning Forward,” Science 16 (July 22, 2002): 11. Testimony of Richard M. Doerflinger, Associate Director for Policy Development at the Secretariat for Pro-Life Activities, United States Conference of Catholic Bishops, before the Subcommittee on Labor, Health and Human Services, and Education, U.S. Senate Appropriations Committee (July 18, 2001). Found at http://www.nccbuscc.org/prolife/issues/bioethic/stemcelltest71801.htm.

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Coalition asserts that an important aspect of law in the United States is its protection of human life. This is based on “an affirmation of the essential dignity of every human being.”16 Because opponents view embryos as humans, their destruction for any purpose, constitutes homicide, which is illegal nationwide. The coalition notes that laws in several states protect embryos outside of the mother’s body, and points to federal laws banning such research, as well as to international documents such as the Nuremburg Code, and the United Nations Declaration of Human Rights. The coalition notes further that medical experimentation requires human consent, and that embryos have not given their consent. The second argument revolves the claim that research on embryos is inherently unethical. Here the argument is based, again, on the premise that embryos are fully human, and fully deserving of full human rights. The coalition points to the horrendous “scientific” experiments carried out in the Nazi death camps during World War II and the Tuskegee syphilis experiments conducted on African-Americans for over forty years as examples of what can happen if humans are treated solely as objects of research. The coalition emphasizes that one lesson of the Nazi and Tuskegee experiments is the importance of obtaining subjects’ consent, and embryos cannot consent. Along the same lines, the coalition and others object to embryonic stem cell research, and therapeutic cloning because they result in the destruction of embryos. Further, opponents object to the notion that embryos have an instrumental value, that is, the stem cells produced from them will help those suffering from diseases. Although these groups are sympathetic to the plight of those suffering from disease and injury, they do not believe that taking a human life to prevent suffering of another human being is justified. The last argument given by opponents is scientific in nature and involves two basic claims. First, research with embryonic stem cells has been discouraging. Second, and more importantly, opponents argue that it is unnecessary. Critics disagree with supporters who argue that the versatility of embryonic stem cells is their major advantage in that they can be stimulated to create virtually any type of human cell; they are totipotent.17 Opponents respond that encouraging new research demonstrates that other kinds of stem cells, such as adult stem cells, can be stimulated to create other kinds of cells. Cells can be derived from bone marrow, blood from the umbilical cord and the placenta, and fetal bone marrow.18 Opponents, specifically those from the Do No Harm Coalition claim that developments in gene therapy lessen the need for embryonic stem cell research. President Bush’s policy decision regarding stem cell research was made more complicated by the deep division over the issue among conservative Republicans. Bush tried to craft a policy designed to strike a political balance between competing political and ethical viewpoints. On the pro stem cell research side were people such as Secretary of Health and Human Services Tommy Thompson; Republican senators Orrin Hatch (Utah), Allen Specter (Pennsylvania), Gordon Smith (Oregon), Bill Fritz (Tennessee), the only physician in the Senate, Strom Thurmond (South Carolina); former senator Connie Mack (Florida); and former First Lady Nancy Reagan. In some cases, the reason for their support was personal. 16

Do No Harm: The Coalition of Americans for Research Ethics, “On Embryos and Stem Cell Research,” (July 1, 1999): 2. Found at http://www.stemcellresearch.org/statement/statement.htm. 17 Alexander Morgan Capron, “Stem Cells, Ethics, Law and Politics,” Biotechnology Law Report 20 (October 2001): 678. 18 Do No Harm, p. 6.

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For Nancy Reagan, her support was based on her husband’s, former president Ronald Reagan, Alzheimer’s disease. For Senator Mack, his personal battle with cancer inspired his support. Hatch made several claims in a letter to Secretary Thompson expressing his support for stem cell research.19 First, he pointed out that he has always been pro-life, and that he opposes abortion. Interestingly, Hatch wrote that some exceptions to his opposition to abortion exist, such as protecting the life of the mother; thus Hatch’s opposition to abortion was not absolute. Hatch also noted that he was one of the leaders in the Senate opposed to fetal tissue research. His position on stem cell research was that it “raises questions and considerations fundamentally different from issues attendant to abortion.”20 Hatch asserted that in vitro fertilization benefits society, and is ethical. Indeed, the Senator considered IVF as basically pro-family, even though more embryos than needed are produced by the procedure. The issue for Hatch was what to do with the remaining embryos. His view was that the frozen embryos are “more kin to a frozen unfertilized egg or frozen sperm than to a fetus naturally developing in the body of a mother.”21 He further observed that the U.S. Supreme Court has never stated that fetuses or embryos are protected by the Constitution. In contrast to Senator Hatch’s views were the testimony and actions of Senator Sam Brownback (R-Kansas.)22 Senator Brownback opposes stem cell research, and has sponsored bills in the Senate that would ban both reproductive and therapeutic cloning.23 Brownback asserts that stem cells are derived from embryos, and that embryos are human. He repeats the points made above that stem cell research is “deeply immoral, illegal and unnecessary.”24 He uses the phrase “slippery slope,”25 arguing that embryonic stem cell research will inevitably lead to cloning since both are based on the idea that the embryo is nothing more than property. He also maintains that embryonic stem cells deserve the same rights and dignity as human beings. Other Republican opponents included Dick Armey (Texas), Senate majority leader Tom Delay (Texas), House majority whip and head of the House Republican Conference J. C. Watts (Oklahoma), and Speaker of the House Dennis Hastert (Illinois). The first three sent a letter to President Bush calling for the complete prohibition of federal funding for embryonic stem cell research.26 Another opponent of embryonic stem cell research is Representative Christopher Smith (R-New Jersey). In the summer of 2003, Smith announced that he was

19

Orrin G. Hatch, “Letter to HHS Secretary Tommy G. Thompson,” in William Kristol and Eric Cohen (eds.), The Future is Now: America Confronts the New Genetics (Rowman & Littlefield, Lanham, MD., 2002), pp. 250-253. 20 Ibid., p. 251. 21 Ibid., 252. 22 Sam Brownback, Testimony before the U.S. Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, in William Kristol and Eric Cohen (eds.), The Future is Now: America Confronts the New Genetics (Rowman & Littlefield, Lanham, MD., 2002), pp. 276-278. 23 See Rich Weiss, “Debate About Cloning Returns to Congress; Senate Considers Ban Affecting Human Embryos,” Washington Post (January 30, 2003). Found through LexisNexis. 24 Brownback, p. 276. 25 For a discussion of the use of the concept of “slippery slope” as a strategic tool in policy debates, see Deborah Stone, Policy Paradox: The Art of Political Decision Making, revised edition (New York: W. W. Norton, 2002), pp. 151-152. 26 Richard Lacayo, “How Bush Got There,” Time 158, no. 7 (August 20, 2001). Retrieved from www. time.com.

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proposing legislation that would create a series of blood banks for storing umbilical cord blood, a source of stem cells.27

PRESIDENT BUSH AND STEM CELL POLICY ALTERNATIVES This then is the situation in which President George W. Bush found himself. He had promised during the 2000 presidential campaign to reverse the Clinton administration position by ending federal funding for embryonic research. Powerful groups to which Bush wanted to appeal, such as Catholics, opposed stem cell research.28 The president certainly wanted their support for his 2004 re-election campaign, and Pope John Paul II specifically asked Bush to ban stem cell research funding.29 However, his course of action was not at all clear since important members of his party supported the research. Substantially more support for stem cell research existed in the Senate than in the House of Representatives.30 Two reports referred to the period before the president’s speech of August 9, 2001, as a “battle” for his soul.31 In many ways this was the most important, and the most public decision of his early presidency. The president had four options.32 Each option had advantages and disadvantages from both a scientific and technological perspective. The first option was to forbid federal funding for such research, a position based primarily on ethical foundations. Under this position, embryos are considered human, the sanctity of human life is an important value, and embryos should not be experimented on without their consent. A problem with this option is that stem cell research would be left to the private sector.33 Profit motives would guide research plans if research were located totally in the private sector. This option would also require research laboratories receiving federal funds to demonstrate that they had separated stem cell research from federally funded research, a difficult contortion.34 Another problem with private sector control is that it would likely lead to a decline in the review of how stem cells were derived.35 Politically, decline in the review of how stem cells are derived would be favored by prochoice groups; however, as noted above, embryonic stem cell research enjoyed support from the Republican Party, and conservatives.

27

See “Representative Christopher Smith Introduces Bill that would Establish National Umbilical Cord Blood Stem Cell Bank,” Kaisernetwork.org (July 28, 2003). Retrieved from http://www.kaisernetwork.org/daily_reports/rep_repro.cfm#19034. 28 Capron. 29 See Victor L. Simpson, “Pope urges Bush Against Stem Cell Research,” Associated Press (July 19, 2001). 30 See Lizette Alvarez, “61 Senators Call for Stem Cell Research,” The New York Times (July 21) and Evan Thomas and Eleanor Clift, “Battle for Bush’s Soul,” Newsweek 138 (July 9, 2001): 28-30. 31 Thomas and Clift. 32 Capron, pp. 689-698. 33 Unless the president prohibited all embryonic stem cell research which, apparently, was not an option considered. 34 One can see the problems in the analogous issue of federal funding for both domestic and international family planning organizations. Pro-life groups have insisted, as have Congress and the two President Bushes, that no organization receiving federal funds could counsel clients about abortion, let alone perform abortions. The result of these federal policies is that family planning clinics have lost funding, even if they separated activities and funding sources. One can imagine research laboratories having to go through the same contortions. 35 Capron, p. 690.

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A second possible option would be to limit support to research using adult stem cells, an approach that has the major advantage of not requiring the destruction of embryos. Capron notes difficulties with this position.36 Much of the research establishment, such as research centers at universities, and at the National Institutes of Health, would not be able to conduct such research. Further, because the science is still at a very early stage of development (the president’s decision coming only three years after embryonic stem cells were first extracted), some problems in the use of adult stems may still occur since adult stem cells may not be sufficiently flexible for prospective needs. The third option, and the one ultimately chosen by President Bush, would allow for federal funding of stem cell research on stem cell lines that had already been developed, but forbid funding for development of new lines which would require the destruction of embryos. The fourth option facing the president was to allow support for both using stem cells and deriving them. This was the position the Clinton administration was considering.37 As noted above, the Clinton-appointed NBAC had recommended allowing the use of embryos left over from IVF procedures as long as appropriate safeguards and procedures were in place. This was the most liberal option, allowing the most freedom for scientific development. For several reasons, President Bush did not really consider this option. First, again as noted, Bush had campaigned against federal funding for research allowing the destruction of embryos. Second, his strong pro-life views and his supporters argued against it. Finally, the president did not want to adopt policies of an administration from the opposing party, particularly one that was headed by a president beset by scandals.38 Politically, little support from Republican and conservative groups for this position existed.

PRESIDENT BUSH’S STEM CELL POLICY Bush agonized over the decision, and consulted with experts in a variety of fields, especially bioethicists.39 The President had six formal meetings in July 2001, and a variety of informal meetings as well.40 Interestingly, the President never sought the opinions of scientists on this issue.41 Two reporters described the President as “Hamlet-like.”42 The reason for his indecisiveness was attributed to the division of opinion in the country, and 36

Capron, p. 691. Capron, pp. 697-698. 38 This can be seen in the foreign policy area. For example, the Bush administration was very reluctant until the spring of 2003 to get involved in trying to achieve a peaceful settlement of the Palestinian-Israeli dispute. Administration officials felt that President Clinton’s personal participation in the peace talks in 2000 and the failure of those peace talks led to an increase in the violence (the second intifada). Further, the administration was opposed to nation building. Both of these views were changed after the September 11, 2001, attacks and the second Persian Gulf War. 39 See Edward Chen and Aaron Zitner, “Policy: Known for Quick Decisions, the President is Agonizing over the Funding of Embryo Research,” Los Angeles Times (July 13, 2001) and Rick Weiss, “For President, No Easy Solution to Stem Cell Debate,” Washington Post (July 13, 2001). 40 Katharine Q. Seelye and Frank Bruni, “The President’s Decision: The President: A Long Process that Led Bush to his Decision,” The New York Times (August 10, 2001). 41 For a discussion of the lack of input of scientists into science policy decisions on this and other issues during the Bush administration, see Nicholas Thompson, “Science Friction.” The Washington Monthly, 35, nos. 7 and 8 (July/August): 11-15. 37

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among his supporters, and to his search for an appropriate compromise. Washington Post reporter Howard Kurtz observed that the process of decision making, and the decision itself, “has all the elements: politics, science, religion, morality, and, for the moment, an indecisive president.”43 On August 9, 2001, President Bush gave his first nationally televised address to the nation. In a didactic manner, the president presented a summary of stem cell research, its potential benefits, and the sources of stem cells. He noted that federal funds were important for the advancement of biomedical research. Bush said that there were two underlying issues: First, are the embryos human life, and therefore, something precious to be protected? And second, if they are to be destroyed anyway, shouldn’t they be used for a greater good, for 44 research that has the potential to save and improve other lives?

The President claimed that scientific developments could lead to serious ethical problems, referring specifically to Aldous Huxley’s Brave New World where people were born in hatcheries. He also noted a recent, troubling scientific development: a research scientist had announced the creation of an embryo specifically for the purpose of obtaining new stem cells.45 Bush stated that he, like most of the country, opposed cloning. He also said that he had “deeply held beliefs” that had an impact on his decision. One such belief was the importance of the scientific research and medical technology in alleviating human disease. He noted that he had spoken with Nancy Reagan about the former president’s Alzheimer’s disease, and that a member of his family had childhood leukemia. On the other hand, he also believed that “human life is a sacred gift from our Creator,” and he opposed a culture where human life was devalued. The President also noted that scientists had promised great discoveries from fetal tissue research, yet eight years later little benefit had been realized. All these considerations suggested to him that he should “proceed with great care.” Based on these considerations, he concluded the following: As a result of private research, more than 60 genetically diverse stem cell lines already exist. They were created from embryos that have already been destroyed, and they have the ability to regenerate themselves indefinitely, creating ongoing opportunities for research. I have concluded that we should allow federal funds to be used for research on these existing stem 46 cell lines, where the life-and-death decision has already been made.

The President also announced the creation of a President’s Council on Bioethics, to be headed by Leon Kass, a politically conservative bioethicist.47 The purpose of the council was 42

Chen and Zitner, “Policy.” Howard Kurtz, “Politics, Science Collide,” Washington Post (July 16, 2001). 44 George W. Bush, “Remarks by the President on Stem Cell Research,” (August 9, 2001). Retrieved from the White House web site: www.whitehouse.gov/news/releases/2001/08/20010809-2.html. 45 Rick Weiss, “Changing Conceptions,” The Washington Post (July 15, 2001). 46 George W. Bush, “Remarks by the President on Stem Cell Research.” 47 Bush’s choice of Kass as president was enlightening. Kass opposes in vitro fertilization and cloning. Kass apparently had a major impact on the option that the president chose. See Amy Goldstein and Mike Allen, “Bush Backs Partial Stem Cell Funding,” The Washington Post (August 10, 2001); and Judy Keen, “Reading, Reflection Brought Bush to Decision,” USA Today (August 10). 43

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to advise the President on bioethical issues, to monitor research in the area, and to recommend policy changes. President Bush’s decision was a political one, designed to arrive at a compromise among competing political interests and ethical values; it was not necessarily based on sound political, ethical or scientific principles. His decision focused only on federal funding for stem cell research, and limited such research to about sixty stem cell lines that the National Institutes of Health stated met President Bush’s conditions. The conditions included 1) the purpose of the creation of the embryos was for reproduction only (i.e., for in vitro fertilization), 2) the embryos were no longer needed, 3) the donors had given their informed consent for the use of the embryos in research, and 4) the donor had not received any financial reward. His decision also asserted that no additional stem cell lines would be created.48

IMPLICATIONS OF BUSH’S STEM CELL DECISION Ethical Implications President Bush portrayed his decision as highly ethical. The sixty or so stem cell lines to which he referred were already in existence; the embryos from which the stem cells were derived had already been used (destroyed), and federal funds would not be used to generate additional lines. However, the decision is ethically inconsistent. If the President adopted the view that preservation of life is important, and all life is sacred, then he should have also called for an end to abortion. If destroying a human embryo is ethically wrong, as the President believes, then destroying a much more developed fetus is ethically wrong. Similarly, as Scott Rosenberg49 notes, thousands of embryos will be destroyed though IVF procedures. Rosenberg then argues that if destroying embryos is destroying human life, then Bush should be against IVF (a position, as noted above, that Leon Kass takes). If President Bush is against the destruction of embryos, he should have called for the closing of fertility clinics. For Rosenberg, the “courageous” stance would be to distinguish “between embryos created with intent to produce life, and those created solely to be destroyed for their stem cells.” A second ethical problem with the decision is there does not seem to be any justifiable rationale for limiting research on stem cell lines already in existence on August 9. As Kahn50 correctly points out, the August 9 cutoff date for stem cell lines is arbitrary. He notes that perhaps as many as 200,000 frozen embryos will eventually be discarded; embryos that could have been used for stem research. This observation leads to two other ethical problems. The President claims that since the decision about the life of the embryo has already been made on the sixty stem cell lines, using these lines is permissible. But if destroying an embryo to 48

National Institutes of Health, “National Institutes of Health (NIH) Update on Existing Human Embryonic Stem Cells,” (August 27, 2001). Retrieved from the NIH web site: www.nih.gov/news/stemcell/082701/list.htm. 49 Scott Rosenberg, “Bush’s Stem-Cell Fumble,” Salon.com (August 20, 2001). Retrieved from dir.salon.com/politics/features/2001/08/10/stem_cell/index.html. 50 Jeffrey P. Kahn, “Missing the Mark on Stem Cells,” CNN.com/health (August 20, 2001). Retrieved from www.cnn.com/2001/HEALTH08/20/ethics.matters.

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create stem cells is ethically wrong, as the President believes, or else he would have permitted federal funding on all stem cell lines regardless of date, then benefiting from such a decision is ethically wrong. An analogous situation is the “scientific” experiments carried out by the Nazis on death camp inmates. One example is the hypothermia experiments. Prisoners were exposed to wintry conditions, and scientists recorded data from the prisoners’ responses. Obviously scientific interest exists regarding the issue under question; i.e., designing appropriate treatment for victims of cold weather. Apart from the Nazi experiments, little other data about this topic is available. If the experiments were morally wrong, as they were on a number of counts, then ethically the tainted data should not be used.51 Furthermore, if destroying an embryo to create stem cells is morally wrong, then it should not matter whether the stem cell lines were created before or after an arbitrarily set date. As Kenneth L. Connor, of the Family Research Council, argues, whether the embryos (or “embryonic children”52 as he calls them) were destroyed before or after the speech is irrelevant. Finally, the President’s major argument against federal funding was based on the principle of nonmaleficence. This ethical principle guides the professional activities of scientists and health providers. Simply stated, the principle means “do no harm.”53 In other words, medical professionals and researchers must not purposely injure patients and research subjects. Applying nonmaleficence to stem cell research, the harm in question is to the embryo, which, some believe, is human, or at the least has human potential. But the President’s decision ignored a second ethical principle, beneficence. This principle states that researchers and health care providers have an obligation to benefit research subjects and patients.54 In the context of the stem cell decision, the beneficence principle would be balanced against the nonmaleficence principle: the concern for preventing harm should be balanced by the promise of healing. Stem cell research does hold the promise of reducing human suffering, and possibly curing disease. Interestingly, an historical parallel can be drawn here. As Eric Cohen points out, President Bush’s decision is analogous to the Missouri Compromise.55 The stem cell decision, like the 1820 legislation that permitted Missouri to enter the Union as a slave state, and Maine as a free state, sought to find a balance of viewpoints, and therefore postpone resolution of the larger issues.

51

For a discussion of the use of such tainted “data,” particularly from a Jewish standpoint, see Baruch C. Cohen, “The Ethics of Using Medical Data from Nazi Experiments.” Retrieved from the Jewish law website: http://www.jlaw.com/Articles/NaziMedEx.html. 52 Kenneth L. Connor, “Bush’s Broken Promise,” in William Kristol and Eric Kohen, (eds.), The Future is Now: America Confronts the New Genetics (Rowman & Littlefield, Lanham: MD: 2002), pp. 3314-3315. The column originally appeared in the Washington Post (August 11, 2001). 53 For a discussion of this principle in the field of psychiatry, see Cynthia M. A. Geppert, “Do No Harm,” Psychiatric Times, vol. 20, issue 7 (July 2003), pp. 91-92. See also the code of ethics of the American Dental Association at http://www.ada.org/prof/prac/law/code/opin02.html. 54 American Dental Association code of ethics at http://www.ada.org/prof/prac/law/code/opin03.html. 55 Eric Cohen, “Bush’s Stem-Cell Ruling: A Missouri Compromise,” in William Kristol and Eric Cohen (eds.), The Future is Now: American Confronts the New Genetics (Rowman & Littlefield, Lanham, MD., 2002), pp. 316318. The column originally appeared in the Los Angeles Times August 12, 2001.

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Scientific Implications One of the important arguments made by the President is that some sixty plus stem cell lines meeting his criteria would be eligible for federal research funding, but scientists examining the National Institutes of Health registry of stem cell lines found far fewer than sixty. In May 2003, the director of the NIH, Elias Zerhouni, announced that only eleven lines were usable for research.56 As of July 21, 2003, almost two years after President Bush’s speech announcing his decision, the NIH listed twelve cell lines that were eligible, though it suggested that there were as many as seventy-eight derivations.57 Having so few lines is very likely to hamper research, and put the United States at a disadvantage as compared to other countries that do not place such limits. An example of the overestimation by President Bush and the National Institutes of Health came when NIH announced shortly after the speech that nineteen of the cell lines had been established in a hospital in Sweden. By the President’s criteria, all were available. The reality, however, was much different. Only three of the nineteen were actually established and usable; four were being studied; and the other twelve were possible stem cells lines. The head researcher at the Swedish hospital was quoted as saying about the twelve possible lines, “If we get 3 good lines out of them we'll be satisfied.”58 Other commentators have noted that research with mouse stem cell lines over several decades has shown that such lines lose some of their viability over time. They “can lose their differentiation potential, become contaminated, accumulate mutations, and tend toward spontaneous or uncontrolled differentiation.”59 Another question raised with existing stem cell lines is whether there is sufficient genetic diversity to represent a human population of over 5 billion people within those lines.60 Apart from these problems, the available stem cell lines are themselves inadequate for supporting embryonic stem cell research. A number of the stem cell lines are privatelyowned. These proprietary companies could charge fees for the use of the stem cells. Kahn points out that the private companies, some associated with universities such as the University of Wisconsin, would stake a claim not only to the stem cells but the research emanating from studies using those cell lines.61 A related point concerns whether the stem cell lines listed in the NIH registry were all viable. The American Society for Cell Biology offered its own criteria for assessing the viability of stem cell lines: 56

Randolph Schmid, “NIH Says Only 11 Stem-Cell Lines Are Available for Research,” The Philadelphia Inquirer (May 9, 2003). 57 See registry at http://stemcells.nih.gov/registry/index.asp. 58 Don G. McNeil, Jr., “In a Tiny Room in Sweden, A Large Trove of Stem Cells,” The New York Times (August 29). 59 Testimony of Douglas Melton, Ph.D., before the Senate Committee on Health, Education, Labor and Pensions (September 5, 2001). Dr. Melton was representing the American Society for Cell Biology. Retrieved from http://www.ascb.org/newsroom/melton9.5.01.html. 60 “Scientists: It’s Not Enough,” ABCNews.com (August 10, 2001), retrieved from abcnews.go.com/sections/scitech/DailyNews/stemcell-researchers010810. See also The American Society for Cell Biology, “Position Paper on Bush Decision on Federal Funding of Stem Cell Research, 2001. Retrieved from http://www.ascb.org/newsroom/positionpaper.html. 61 Jeffrey P. Kahn, “Missing the Mark on Stem Cells,” CNN.com (August 20, 2001). Retrieved from www.cnn.com/2001/HEALTH/08/20/ethics.matters.

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(1) They must truly be available to both public-funded research scientists located at the NIH and at universities, academic health centers and research institutes throughout the Nation. (2) They must be free of restrictions that would impede publicly funded investigators from seeking important disease treatments. (3) They must be capable of robust growth. (4) Sufficient information must be available about each line's derivation so that it can be grown and handled under reasonable conditions. (5) Each of the approved lines must retain the important capacity to generate the three early 62 embryonic cell types: ectoderm, mesoderm and endoderm.

The scientific society expressed some skepticism as to whether the sixty lines, if there really were sixty lines, could meet those criteria. Further, the society noted that over the next several years, new and enhanced lines might become available, but federal funding of research using those lines would be prohibited.63 Thus, the society implied, biomedical progress in this promising area would be stymied. Furthermore, the federal government has continued to fund, and increase funding for adult stem cell research. For example, in January 2003, NIH announced that it was providing $1.4 million for five studies using adult stem cells. Robert Lanza, the vice president at one of the major private companies conducting stem cell research, Advanced Cell Technology, argued that the decision was essentially a political one. The decision follows from the limits placed by President Bush’s decision, and by Congressional Republicans who are against embryonic stem cell research. The NIH, according to Lanza, is responsive to congressional views on this issue. Lanza pointed out that similar funding for embryonic stem cell research would have led to clinical trials.64 Some observers considered this to be indicative of the real intent of the President’s decision to hinder embryonic stem cell research, and foster adult stem cell research.65 Finally, the restrictions imposed by the federal government (and by states banning therapeutic cloning) led to a concern about “brain drain.” A number of prominent scientists began to leave the United States, and had moved to countries that were less restrictive. Singapore was one place that was attractive to scientists seeking to continue research in this area.66 England was another possible destination.67 Both England and New Zealand were in the process of making it easier for scientists to engage in embryonic stem cell research.68 One example of a scientist emigrating to another country is Dr. Roger Pedersen of the University of California at San Francisco, who left his tenured position to go to England to continue his

62

The American Society for Cell Biology, “Position Paper on Bush Decision on Federal Funding of Stem Cell Research, 2001. Retrieved from http://www.ascb.org/newsroom/positionpaper.html. 63 Ibid. 64 Steve Mitchell, “Experts: Bush Stem Cell Policy Limits NIH,” United Press International (January 3, 2003). 65 See Steve Mitchell, “Experts: Bush Stem Cell Policy Limits NIH,” United Press International (January 3, 2003). 66 “Send in the Clones; Biotechnology in Singapore,” The Economist (August 24, 2002). Retrieved from infotrac service. 67 Jeffrey P. Kahn, “Stem Cells and a New Brain Drain,” (July 9, 2001). Retrieved from www.cnn.com/2001/HEALTH/07/23/ethics.matters. 68 See, for example, “Britain Authorizes New Stem Cells Line for Geron,” Associated Press (June 11, 2003) and “Researchers Can Begin Process for Stem Cell Permission,” AAP (May 16, 2003). Retrieved from Lexis/Nexis. See also, “American and British Governmental Views of Human Stem Cell Research,” Morning Edition, National Public Radio (December 31, 2002).

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research.69 And, Edison Liu, who worked at the National Institute of Cancer, left for Singapore.70 Gerald D. Fischbach, writing in Newsweek, argued that apart from the possible alleviation of human suffering through stem cell research, the President’s decision will damage “the fabric of America’s extraordinary culture of inquiry and technical development in biomedical sciences.” 71 He anticipates that scientists will either move to other countries or leave the field entirely. An example of the latter is Jose Cibelli, a researcher at Advanced Cell Technology, who had spent five years working in this area. He quit his job to become a faculty member at Michigan State University, and went on to conduct research in another area.72

Political Implications As is typical in politics, public policy decisions rarely settle an issue. Bush’s compromise was unsatisfactory to both liberals and conservatives. Congressional legislation introduced as early as September 2001 was aimed at allowing more liberal funding of embryonic stem cell research, although some legislators sought to cut such funding completely. Some of the legislation focused on cloning, with most of the proposed bills banning both reproductive and therapeutic cloning.73 For example, H.R. 534, the Human Cloning Prohibition Act of 2003, passed the U. S. House of Representatives in February 2003, banning any kind of cloning. Senator Sam Brownback (R-Kansas) introduced legislation banning both kinds of cloning, and Senator Arlen Specter (R-Pennsylvania) proposed legislation that would ban reproductive cloning but allow therapeutic cloning under certain conditions. Universities, foundations, corporations, and state governments also have responded. States as diverse as New York and Tennessee were considering legislation to allow such research outside of the President’s guidelines. Some states, particularly California, sought to promote embryonic stem cell research74 while others sought to ban both types of cloning.75 Foundations in disease specific areas (such as diabetes) began to fund stem cell research. Corporations engaged in research using their own funds or donated money. Opponents of such research started pressing for stricter federal regulations.76 This demonstrates the plurality of views on the matter. 69

“Two Scientists' Embryonic Research Leads Them in Opposite Directions,” Morning Edition, National Public Radio (January 1, 2003). 70 “Send in the Clones: Biotechnology in Singapore,” The Economist (August 24, 2002). 71 Gerald D. Fischback, “The Dangers of Delay: Restrictions on Stem-Cell Research in the United States Will Exact Costs on American Doctors as well as Potential Patients,” Newsweek (January 13, 2003). 72 Paul Elias, “Politics Stalls Stem-Cell Work,” The Seattle Times (November 18, 2002). 73 See National Institutes of Health, “Pending Stem Cell Research and Cloning Legislation,” retrieved from www.stemcells.nih.gov/fedPolicy/pending?Legis.asp. 74 Aaron Zitner, “States Challenge Bush on Embryonic Stem-Cell Research,” The Los Angeles Times (November 29, 2002) and Richard Perez-Pena, “Broad Movement is Backing Embryo Stem Cell Research,” The New York Times (March 16, 2003). 75 See, for example, the stories in “Michigan House Committee Approves Bill that would Ban Importation of Embryonic Stem Cells for Research,” (March 13, 2003) at www.kaisernetwork.org. 76 Richard Perez-Pena, “Broad Movement is Backing Embryonic Stem Cell Research,” The New York Times (March 16, 2003).

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CONCLUSION The controversy arising from, and the effects of President Bush’s August 9, 2001, stem cell decision remain. Since policy decisions are often results of political compromises rather than clear principles—typical in the American political system—policy decisions are rarely final. Battles over the same policy issues are continually re-fought, and such is the case with President Bush’s embryonic stem cell research policy. President Bush’s decision was limited to federal support for stem cell research. His decision did not address the larger issue of whether such research should be banned in the first place, as was the case with the issue of cloning (both reproductive and therapeutic). As we have seen, President Bush’s policy on federal funding of embryonic stem cell research is flawed, and these flaws occur in three areas: scientific, political, and ethical. It is quite likely that no policy decision will have more long lasting importance for American society than how the federal government should approach the issue of research on embryos. In implementing his policy on stem cell research, President Bush appears to have ignored or abrogated his responsibility to carefully consider the scientific expertise, the ethical merit, and the political leadership required to craft a national stem cell policy.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 51-62

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

THE ‘BLAME GAME’: WHAT WENT WRONG WITH HEALTH CARE REFORM

Gary D. Wekkin ABSTRACT Competing causal stories explaining the Clinton administration’s failure to win enactment of health care coverage reform are compared here against each other, and against the documentary records of the White House Health Care Interdepartmental Working Groups, which have been opened to the public by the Clinton Presidential Materials Project. The documents, which are not yet complete, reinforce the critiques provided by participant-observers such as Sidney Blumenthal, David Gergen, and George Stephanopoulos, and by veteran White House watchers such as Elizabeth Drew, Joe Klein, Haynes Johnson, David Broder, and Bob Woodward, rather than the explanation tendered by the Clintons. The process by which the White House health care reform proposal was produced was so flawed that it may have been by itself sufficient cause for the defeat of the proposal.

INTRODUCTION Competing explanations for the failure of the Clinton health care reform proposal to pass in 1993-94 abound. Economic determinists look no further than the fact that the $1 trillion-ayear health care industry accounted for one-seventh of the gross domestic product of the United States1 spends over $100 million annually just on lobbying the federal government,2 and pumped $30 million into the ‘Harry and Louise’ advertising campaign (versus a $150,000 Democratic National Committee campaign in reply) against the Clinton health care reform proposal.3 Skocpol’s analysis, in particular, concludes not only that interest group-dominated “money-driven elections”4 deprived the Clinton health care proposal of the unified backing of 1

Theda, Skocpol, Boomerang (New York: W.W. Norton, 1996), 48. www.opensecrets.org/lobbyists/index.asp 3 Sidney Blumenthal, The Clinton Wars (New York: Farrar, Strauss & Giroux), 118. 4 The concept of “money-driven elections” is Thomas Ferguson’s. See his Golden Rule (Chicago: University of Chicago Press, 1995). 2

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Democratic constituency groups, and of the Democratic majorities in Congress, but that the sheer size of the annual budget deficit, and overall national debt inherited by the Clinton administration ($300 billion and $3 trillion, respectively) effectively “imprisoned [it] within a fiscal environment that makes it difficult for government to do anything.”5 In brief, the staggering federal debt and deficit deprived the Clinton White House of public trust, and confidence in government solutions, and of recourse, to tax increases to finance health care coverage, therefore forcing it to propose a plan in which health care remained privatized, but subject to very heavy regulation in order to keep costs down while making health care coverage universal.6 However, Washington insider accounts by those who served in the Clinton White House. or covered the White House on a daily basis, point out a myriad of problems in how the Clinton health care proposal was produced, and put forward. Many present the plan itself as flawed from the start; a highly detailed “regulated market competition” approach, and at 1,342 pages, was so cumbersome that it lent itself to charges of “big government” as readily as if it were a government-operated “single-payer” plan. Some ascribe this to the inexperience of those in charge of producing the plan, First Lady Hillary Rodham Clinton and Ira Magaziner; even Mrs. Clinton now writes that “Bill had assigned Ira the task of setting up the process for health care reform, which turned out to be an unfair burden for someone who was not a Washington insider;”7 and to their unwillingness to listen to those who were insiders with such experience.8 The plan had been formulated in-house; thus the First Lady’s (and therefore the President’s) fingerprints were all over it, through a tightly controlled process, with too little input from the private sector (the Task Force even selected its own critics, referred to as “Contrarians”).9 All of these liabilities could have been avoided had the assignment been given instead to an administration official with appropriate line authority and resources, such as Health & Human Services Secretary Donna Shalala.10 Other participants and observers fault the start-and-stop manner in which the plan was rolled out, explained, and marketed to the public;11 and the mixed signals that the Clinton White House sent to Congress by sidetracking health care reform in favor of so many other 5

Skocpol, 1996, 83-87, 176. Skocpol, 1996, 173-83. 7 Hillary Rodham Clinton, 2003. Living History (New York: Simon & Schuster, , 153. Mrs. Clinton does not say so directly, but it is left between the lines here that she, too, was not then a Washington insider prepared for such a burden. 8 See the section on Candor in Short Supply below. 9 “Health Professionals to Review Clinton Proposal as it Develops,” Draft Press Release, 13 April 1993 (White House Health Care Interdepartmental Working Group, Papers of Ira Magaziner, Box 367, Folder 4, Clinton Presidential Materials Project, Little Rock AR), announces the names of 46 practicing health care professionals selected by Mike Lux, Special Assistant to the President for Public Affairs, to serve as “an outside ‘reality check’ to advise the Task Force.” 10 David Gergen, veteran adviser to Clinton and four other presidents, writes that “Primary responsibility for design of the program should have been assigned to the lead cabinet officer in health affairs, Donna Shalala….Ms. Shalala has been a successful president of two universities and a shrewd policy-maker. With marching orders from the president on his goals, she could have drawn upon the expertise of her department, worked with Congress, the cabinet, academics, and outside groups, and kept the White House in the loop” (2000, 307). Haynes Johnson and David Broder’s The System (Boston: Little, Brown, 1996), 112 concurs that the proposal should have been assigned to HHS. 11 Skocpol, 1996, 107-32; see also Jeffrey Birnbaum, Madhouse (New York: Times Books, 1996), 59-103. 6

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issues of the moment, such as deficit reduction, economic stimulus, welfare reform, and NAFTA, and by wasting its leverage on ill-advised nominations.12 Some of course argue that the Clinton White House should have asked the Congress itself to formulate the health care reform legislation: in the words of journalist/Clinton aide Sidney Blumenthal, “The very idea of having the bill originate from an administration council rather than from within the Congress had given no one on Capitol Hill ownership of health care reform.”13 President Clinton himself now seems to have joined this school of thought, having acknowledged that the First Lady’s task force should only have produced a general statement of principles, and then said, “‘Okay, here’s all of our work…you guys draft the bill.’ Or, I should have insisted that we have a joint bill.”14

HEALTH CARE DEFEAT: THE CLINTONS’ EXPLANATION Interestingly enough, as the remarks attributed to President and First Lady Clinton in the two preceding paragraphs suggest, both of the Clintons seem to emphasize tactical, rather than structural, explanations of their failure to pass health care reform. To be sure, both mention in passing that insurance and medical interests had more money to spend on advertising and lobbying against health care reform than the Democrats, and their allies had to spend in favor of it; Mrs. Clinton specifies that the opponents of reform spent an estimated $300 million compared to only $15 million spent by its supporters.15 The President said that he chose regulated managed care because the deficit he inherited made it impossible to raise taxes, and simply expand Medicaid and Medicare.16 For the most part, however, the explanations released by both Clintons during the summer of 2003 dwelt mainly upon various tactical political considerations. In a nationallytelevised lecture recapping his presidency for University of Arkansas-Little Rock students on May 23, 2003, President Clinton again sounded the themes that the White House’s Health Care Reform Task Force should have just identified its destination, and let Congress do the driving, or worked together with Congress to produce a compromise bill. “I offered to send a general bill to Congress, as Hillary wanted to do, with a report of our findings, and Dan Rostenkowski said, ‘no, you can’t do that, we want a bill (Clinton’s emphasis); the whole nine yards.’”17 (This statement was one of four Clinton made that night exculpating Mrs. Clinton from responsibility for the failure of health care reform.)18 He also faulted Senator Bob Dole’s presidential ambitions, and the fear of rightwing strategists, such as Bill Kristol, that successful health care reform legislation would make voters believe in government (and the Democrats) again, for Republican refusals to accept the President’s offer to work on a 12

Birnbaum, 1996, 15-57; H. Clinton, 2003, 182-83. Blumenthal, 2003, 122. 14 President Clinton, quoted in Joe Klein, The Natural (New York: Broadway Books, 2002), 126. 15 H. Clinton, 2003, 233. 16 www.ualr.edu/~presidents/ClintonImp/TOC.html 17 www.ualr.edu/~presidents/ClintonImp/TOC.html 18 The President was emphatic that any mistakes were his, not the First Lady’s—e.g., “Hillary got a bum rap on that thing…I am a hundred percent responsible for this”—leaving little doubt as to whose political viability has not expired. 13

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compromise bill.19 Bracketing those two obstacles, however, the President’s first and last statements about what went wrong convey his sense that the health care initiative’s greatest problem was its timing, given the pace of a crowded first-year agenda: I think I made a mistake in not passing welfare reform before health care reform….[During 1993] I had this big economic plan, we had NAFTA on the way, we had to bail out Russia once financially, we had the Brady bill, we got the Family Medical Leave bill through…all in just one year….I should have done welfare reform first, and waited another year to do health 20 care.

First Lady Hillary Rodham Clinton’s Living History (2003), published less than a month later, echoed these very same themes; the President called the shots on health care strategy (pgs. 143-44, 150, 182-83), the Clintons’ preference for presenting Congress a general outline of principles (p, 191), Rostenkowski’s preference for a fully-specified bill (p. 191), Clinton’s willingness to compromise with Republicans, Dole’s feet of clay and Republican strategists’ “scorched earth” mentality (pgs. 190, 230-31, 247), and the timing of health care reform and welfare reform, respectively (pgs. 151-52, 182-83), plus the considerable lack of unanimity among Congressional Democrats about whether to back a “single-payer” system, or incremental extension of Medicaid and Medicare benefits to most (but not all) uninsured Americans, or the President’s ‘middle-way’ regulated managed care approach (pgs. 149-53). Clearly then, the Clintons’ forensic analysis of the “cause of death” of health care reform tilts away from the structural or economic determinist view that the effort was doomed at birth by “the system,” in favor of ad hoc, “inside baseball” reconstructions of who did what, and when, to kill the victim. If we accept the basic premise of the latter school of thought, which is the perception (shared by the Clintons, and many participants and observers) that health care reform legislation could have been saved had it been done differently, then we are left a ‘whodunit’ to solve. Are the President and/or the First Lady to blame for events that undermined the process; i.e., the very restricted, in-house drafting process, the comprehensive nature of the approach taken by the White House bill, the unwillingness of the Republicans to support any kind of health care bill at all (even a compromise), the fissures within the Democratic majorities; or were these matters over which the Clinton White House had little or no control, that must be credited to the opponents of reform?

WHAT THE AVAILABLE HEALTH CARE REFORM DOCUMENTS SHOW Because President Clinton chose to make the records of the White House Health Care Inter-Departmental Working Group open to the public in early 2003, there is now documentation available against which the claims of the participants themselves (e.g., both Clintons, Stephanopoulos, and Gergen), and their watchers (e.g., Blumenthal, Klein, Drew, 19

Such partisan competitive considerations are given great weight in the thinking of Skocpol (1996) and of Johnson and Broder (1996), respectively, whose books on the defeat of health care reform each argue that the American political system has become unworkable because of such partisanship. 20 www.ualr.edu/~presidents/ClintonImp/TOC.html

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Birnbaum, and Johnson & Broder), can be measured. The White House’s own files on health care reform remain closed, however, which means that the files not only of First Lady Clinton but of some of the most important staff players in the health care policy process (e.g., Chris Jennings) are not yet available. Thus, what follows is an incomplete analysis that sheds additional, but not perfect, light on the claims made by the participants and the media observers. Indeed, because the files that have been opened are not those of the White House, nor even those of the White House Health Care Task Force, but rather those of the staff-level Inter-Departmental Working Groups created by Ira Magaziner, there are some questions regarding which there is not yet any telling documentary evidence available. Foremost among the latter questions is the nature of the Clinton health care proposal that was developed, including how and why such a comprehensive plan was developed when the preference of both Clintons was to present Congress a more general statement of health care principles, to be fleshed out by the legislative process.

A COMPREHENSIVE PLAN The Clintons’ respective statements in 2003 about preferring to send Congress a general statement of health care principles, rather than a comprehensive plan consisting of specifics, are at odds with the actions taken a decade earlier, as well as with retrospective statements that were made soon after the 1994 demise of the Clinton health care plan. In the first place, a mere general outline of health care reform philosophy and principles should not have required the services of Ira Magaziner, a professional consultant known for complex organizational plans such as a 400-page study of the health care system of tiny Rhode Island, an 1100-page economic development plan for Rhode Island known as “The Greenhouse Compact” (which was defeated in a statewide referendum), an ambitious national apprenticeship and jobtraining program that “would have reorganized America’s high school curriculum”and imposed a mandatory training fee on companies lacking their own training programs (Mrs. Clinton was involved with this proposal as a board member); and a 400-page revision of Brown University’s undergraduate curriculum that he had prepared during the summer of his sophomore year there, which Brown enacted in 1969.21 Clearly, if the Clintons intended only a general roadmap for health care reform that left the actual driving to Congress, they had picked the wrong man for the job; and they picked him in early January 1993. In the second place, the President himself told Haynes Johnson and David Broder in an interview during the Summer of 1995 that his mandate to the White House health care task force he had created (to avoid Cabinet infighting, according to Mrs. Clinton) had been to produce a comprehensive health care plan. In Mr. Clinton’s own words, “It seemed to me that all aspects of this problem were sufficiently interrelated that we ought to try to have a comprehensive solution.”22 Indeed, there are many indications that Mr. Clinton had arrived at his middle-way, “regulated managed care” approach to health care reform by the time of his now-famous 21 22

Johnson & Broder, 1996, 104-07, 113-14. Johnson & Broder, 1996, 98.

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campaign speech on health care reform at Merck Pharmaceutical Company in Rahway, New Jersey, on 24 September 1992. Johnson and Broder identify the speech, and the approach it contained, and the health care briefing that prepped it, as having “determined the basic substantive approach he would take to health care as President; and, equally important, established the political strategy he would pursue in office to achieve his reforms.”23 This is a view that is confirmed by Skocpol, who was given considerable research access to Mrs. Clinton, Mr. Magaziner, and their documents in early 1995.24 Given these antecedents (and the President’s threat during the 1994 State of the Union address to veto any health care bill that did not include universal coverage)25 it is difficult to accept the 2003 claim that the Clintons’ preference would have been to draft a general bill stating reform principles, but that congressional leaders insisted they create an opus instead.

INCLUSIVE GOALS: INCLUSIVE PROCESS? Mrs. Clinton’s book depicts a process that was more open than has been depicted by many critics: (1) “Bill had assigned Ira the task of setting up the process for health care reform…;” (2) “In addition to the President’s Task Force, which consisted of me, the Cabinet secretaries, and other White House officials, Ira organized a giant working group of experts…;” (3) “This group [the White House Health Care Inter-Departmental Working Group], comprising as many as six hundred people from different government agencies, Congress, and health care groups, including physicians, nurses, hospital administrators, economists, and others, met regularly with Ira to debate and review specific parts of the plan…;” (4) but “the attempt to include as many people and viewpoints as possible—a good idea in principle—ended up weakening rather than strengthening our position” because some participants frustrated by the large, unwieldy nature of the process stopped participating; (5) yet, despite the fact that “There was certainly nothing secret about hundreds of people participating in this process,” health care interest groups who were not included in the task force process sued in order “to foster an impression with the public and the news media that we were conducting ‘secret’ meetings.”26 While Mrs. Clinton is certainly correct that the interest groups that sued did so to embarrass, and even impede the health care reform task force and working groups; the process set up and overseen by Mr. Magaziner was such that its opponents did not have to work very hard.

Task Force Membership Limited On 25 November 1992, three Republican U. S. Senators; Nancy Landon Kassebaum (KS), John Danforth (MO), and Conrad Burns (MT); and three Democratic House members; Dan Glickman (KS), Dave McCurdy (OK), and Pat Roberts (KS), wrote to President-elect 23

Johnson & Broder, 1996, 89-90. Skocpol, 1996, passim. See also Gergen (2000, 300). 25 Blumenthal, 2003, 122; Gergen, 2000, 309; H. Clinton, 2003, 219. 26 H. Clinton, 2003, 153-54. 24

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Bill Clinton at his transition team office in Little Rock, offering their assistance in passing his health care reform package. In doing so they touted their own proposal (BasiCare, which would provide comprehensive access to the uninsured, and hold down health care costs by instituting government-set price ceilings) as a compromise between single-payer and managed competition models.27 As such, their proposal was less reliant upon market forces than a managed-competition model embraced by President Clinton in September 1992 (at Merck), and preferred by many conservative Democrats, such as Rep. Jim Cooper (D-TN). Surely, then, there were at least three, perhaps four Republican votes in the U.S. Senate that could have been courted, and won along with those of the Democratic majority. Yet, when President Clinton announced the composition of the formal White House Health Care Reform Task Force after his inauguration, none of the six signers of the November 25, 1992 missive was included in the Health Care Reform Task Force, even though the standard operating procedure of congressional party leaders for a decade had been to practice the “in at the beginning, in at the end” strategy of building roll-call voting coalitions by creating large “task forces” to study, and prepare legislation from the ground up.28 Instead of practicing such inclusiveness in order to assemble a legislative coalition with a better chance of winning, it appears that, consistent with William Riker’s theory of minimum winning coalitions (the smaller the margin of victory, the larger the share of rewards for the victors),29 the Clinton White House elected to take its chances on passing health care reform with the support of Democrats only. As one account notes: Mrs. Clinton preferred to proceed with a “fifty-one vote” strategy: get enough votes from Democrats (with one Republican ally, Senator James Jeffords of Vermont) to pass something as close to the administration’s bill as possible.30 Accordingly, joining Mrs. Clinton and Mr. Magaziner on the Task Force were four Cabinet members whose jurisdictions in some way include provision of governmental health care benefits; Les Aspin (Defense), Robert Reich (Labor), Donna Shalala (Health & Human Services), and Jesse Brown (Veterans Administration). Two more Cabinet members, who would have to reckon with the fiscal requirements of the proposal; Lloyd Bentsen (Treasury) and Leon Panetta (Office of Management & Budget) were added. And, others included three senior White House staff, Robert Rubin (Assistant to the President for Economic Policy), Carol Rasco (Assistant to the President for Domestic Policy), and Laura D’Andrea Tyson (Chair, Council of Economic Advisors); the majority leaders and minority leaders of the congressional chambers through which the proposal must pass; Sen. George Mitchell (D27

Nancy Landon Kassebaum, Conrad Burns, John C. Danforth, Dan Glickman, Dave McCurdy, and Pat Roberts, Letter to President-Elect Bill Clinton, 25 November 1992 (White House Health Care Inter-Departmental Working Group, Papers of Atul Gawande, Box 206, Folder 10, Clinton Presidential Materials Project, Little Rock, Arkansas). 28 See Barbara Deckard Sinclair, “The Speaker’s Task Force in the Post-Reform House of Representatives,” American Political Science Review 75 (1981), 397-410; Barbara Deckard Sinclair, “Leadership Strategies in the Modern Congress,” in Christopher J. Deering, ed., Congressional Politics (Washington DC: Congressional Quarterly Press); and James C. Garand, “The Socialization to Partisan Legislative Behavior: An Extension of Sinclair’s Task Force Socialization Thesis,” Western Political Quarterly 41 (1988), 391-400. 29 William H. Riker, The Theory of Political Coalitions (Westport CT: Greenwood, 1984). 30 Elizabeth Drew, On the Edge: The Clinton Presidency (New York: Simon & Schuster, 1994), 435. Further testimony that this was the strategy is provided in “Clinton’s Legislative Strategy Falters,” Congressional Quarterly Almanac 1994 (Washington DC: CQ Press, 1995), 29; Gergen, 2000, 302; and Klein, 2002, 124.

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ME), Rep. Dick Gephardt (D-MO), Sen. Bob Dole (R-KS), and Rep. Bob Michel (R-IL); and two governors from each party because the states currently provide Medicaid, and could play a role in the extension of health services to the uninsured; Govs. Roy Romer (D-CO) and Howard Dean (D-VT), and Govs. Carroll Campbell (R-SC) and George Mickelson (R-SD).31 What did not fit into the logic of the above appointments was the Task Force membership of seven members of the Congressional Women’s Caucus—Reps. Rosa DeLauro (CT), Maria Cantwell (WA), Eva Clayton (NC), Eddie Bernice Johnson (TX), Barbara Kennelly (CT), and Sens. Barbara Mikulski (MD) and Barbara Boxer (CA), Democrats all32—as opposed to those members of the House and Senate who had been interested enough in health care reform to have earned an identity with the issue, such as Senators Ted Kennedy (D-MA) and John Chafee (R-RI) and Rep. Jim Cooper (D-TN), for example, or the three Democratic House members, and three Republican senators who had volunteered back in November to work with the incoming administration on health care reform. Two of those interested but not included would later team to successfully enact their own health care reform act, the Kennedy-Kassebaum bill that insured the portability of health care coverage from job to job. Neither Republican cooperation nor even intense interest from Democratic congressional entrepreneurs seemed to be wanted; legislation along the lines of the White House model was the goal. Not surprisingly, this resulted in congressional demands for more input in the process: during a closed meeting with Mrs. Clinton on March 17, 1993; tensions arose between Mrs. Clinton and congress members when her response to their demand for more input was that 100 congressional aides were involved in Magaziner’s inter-departmental working groups, to which the members countered that aides do not make the decisions on Capitol Hill.33

Behind Closed Doors The similar demands of health care interest groups for more input into the formulation of the proposal also came as little surprise, given public statements by Ira Magaziner that “We are not going to give the special interests a special seat at the table.”34 True to his word, Magaziner appears to have attempted to “stack” public feedback to the plan by “leading the parade”: forty-six doctors, nurses, and other health care professionals were selected to review the health care proposal as it developed, providing “an outside ‘reality check’” for the Task

31

Medical Group Management Association, 1993 Legislative and Regulatory Briefing, pp. 10-11 (White House Health Care Inter-Departmental Working Group, Papers of Linda Grabel, Box 220, Folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). 32 Ibid. 33 Dana Priest, “Health Benefits Tax Still Possible, Hillary Clinton Says,” Washington Post, 18 March 1993, A14. 34 National Journal Congress Daily, 22 March 1993, pg. 4 of 5 (White House Health Care Inter-Departmental Working Group, Papers of Roger Berry, box 74, folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). Magaziner’s arrogance was a problem noted by many (see, e.g., Johnson & Broder 1996, 14, 81).

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Force;35 a strategy that appears to have been recommended by fellow management consultant David Raab.36 Although a draft copy of the April 13, 1993 press release announcing the selection of these health care professionals indicates that Mike Lux, Special Assistant to the President for Public Affairs, “helped assemble the group,”37 staff memoranda indicate that the names of possible “contrarians” who might be selected to serve in the group were submitted by staff to Magaziner,38 and the draft press release itself was submitted to First Lady Clinton’s chief of staff, Maggie Williams, with carbon copies to Magaziner and Williams’ deputy chief of staff Melanne Verveer, five days in advance of the suggested date of release.39 The 511 members of the Inter-Departmental Working Groups were instructed to observe strict silence about their work for fear that leaks would prompt unwanted interest group, media, and congressional attention,40 and to refer all interest group, media, and congressional requests for information to Michael Lux, Bob Boorstin, and Chris Jennings, respectively.41 Indeed, the Clinton White House did not release to the public for a very long time the composition of the White House Health Care Task Force’s various Inter-Departmental Working Groups, ostensibly “to stop reporters and lobbyists from badgering the staff,”42 which prompted one physicians’ group to file a lawsuit (Association of American Physicians & Surgeons, Inc. v. Clinton) to force the Working Groups to hold open public meetings that representatives of the group could attend.43 Thereafter, the Task Force and working group procedures set up by Magaziner continued as before, but now following guidelines that assured nominal (as opposed to substantive) compliance with the court order, and opinion of the district court by changing the nomenclature of working procedures.

35

“Health Professionals to Review Clinton Proposal as it Develops,” Draft Press Release, 13 April 1993 (White House Health Care Interdepartmental Working Group, Papers of Ira Magaziner, Box 367, Folder 4, Clinton Presidential Materials Project, Little Rock AR). 36 David Raab, “A Contrarian Perspective on Managed Competition,” 4 January 1993 (White House Health Care Interdepartmental Working Group, Papers of Ira Magaziner, Box 358, Folder 2, Clinton Presidential Materials Project, Little Rock AR). 37 “Health Professionals to Review Clinton Proposal…,” Draft Press Release, 13 April 1993. 38 Jennifer Klein, Memo to Ira Magaziner, no date (White House Health Care Interdepartmental Working Group, Papers of Ira Magaziner, Box 367, Folder 4, Clinton Presidential Materials Project, Little Rock AR). 39 Bob Boorstin, Memo to Maggie Williams re “Announcement of Health Professionals Review Group,” 8 April 1993 (White House Health Care Interdepartmental Working Group, Papers of Ira Magaziner, Box 367, Folder 4, Clinton Presidential Materials Project, Little Rock AR). 40 “Task Force’s Regimen of Deadlines, Debates,” Washington Post 16 April 1993, A12 (in White House Health Care Inter-Departmental Working Group, Papers of Roger Berry, Box 74, Folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). See also Dana Priest and Michael York, “First Lady is a Government ‘Outsider,’ Judge Rules,” Washington Post, no date, found in same folder and box; and Klein, 2002, 120. 41 “Health Care Reform Working Group Guidelines,” no date (White House Health Care Inter-Departmental Working Group, Papers of Alline Norman, Box 423, Folder 8, Clinton Presidential Materials Project, Little Rock, Arkansas). 42 “Task Force’s Regimen of Deadlines, Debates,” Washington Post 16 April 1993, A12 (in White House Health Care Inter-Departmental Working Group, Papers of Roger Berry, Box 74, Folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). See also Dana Priest and Michael York, “First Lady is a Government ‘Outsider,’ Judge Rules,” Washington Post, no date, found in same folder and box. 43 This lawsuit and its outcome and implications are covered by Barbara C. Burrell, “The Governmental Status of the First Lady in Law and Public Perception,” in Lois Duke Whitaker, ed., Women in Politics: Outsiders or Insiders? 3rd ed. (Upper Saddle River NJ: Prentice Hall, 1999), 233-47.

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For example, Task Force and working group members received a “privileged and confidential attorney-client/work product” providing guidelines for meetings with the President to discuss health care issues: each meeting is convened by the President; persons attending do so in their individual capacities as government officials or members of a working group or the Task Force, but do not represent the working group or Task Force, and have no authority to speak for either; nor have such individuals been designated a subgroup or subcommittee by either; the President seeks only information or advice from the individuals attending, not advice from the group as a whole, at these meetings; no business of the Task Force or working group is conducted at these meetings; no documents normally will be presented to the President during these meetings, and any that are will not be documents provided by the working group for purpose of advising the president; and if such meetings are listed in the President’s schedule, they shall be described as “meetings with individuals to discuss health care reform.”44 Working Group participants were admonished anew to “be discreet.”45 Federal employees cannot disclose what hasn’t been made public by the White House, should communicate with other government staff only on a “need to know” basis, should not “gossip regarding confidential information,”46 and should check first with Bob Boorstin “on all publications, testimony, communications.”47

Candor in Short Supply A final flaw in the health care reform formulation process appears to have been that second-guessers inside the Clinton administration were little more welcome than those from outside. At the Inter-Departmental Working Group level, and at the Task Force level alike, few messengers were spared when they raised doubts about the plan or the process, until they learned to keep their silence. Stephanopoulos recalls that Mrs. Clinton’s “position stifled healthy criticism about our strategy, and Hillary became the object of some quiet resentment because no one was ever quite sure what the rules were in internal debates.48 Some of those who attended the task force meetings found the First Lady “intimidating, hard to argue with, and uninterested in the points they made.” As one of them said, “There was a little feeling on her part of ‘You’re not in my caste, and I’m not going to debate you’ even when she said, ‘Great, let’s debate this.’ You can’t debate across caste lines.”49 White 44

“Guidelines for Meetings with the President to Discuss Health Care Reform Issues” (White House Health Care Inter-Departmental Working Group, Papers of Peter Kemper, Box 277, Folder 6, Clinton Presidential Materials Project, Little Rock, Arkansas). 45 Ira Magaziner, during 29 April 1993 meeting, in personal notes taken by Kathy Lohr (White House Health Care Inter-Departmental Working Group, Papers of Kathy Lohr, Box 341, Folder 1, Clinton Presidential Materials Project, Little Rock, Arkansas). 46 Richard Worksman (Office of Legal Counsel) during 29 April 1993 meeting, in personal notes taken by Peter Kemper (White House Health Care Inter-Departmental Working Group, Papers of Peter Kemper, Box 277, Folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). 47 Bob Boorstin during 29 April 1993 meeting, in personal notes taken by Peter Kemper (White House Health Care Inter-Departmental Working Group, Papers of Peter Kemper, Box 277, Folder 4, Clinton Presidential Materials Project, Little Rock, Arkansas). 48 George Stephanopoulos, All Too Human (Boston: Little, Brown, 1999), 302. 49 Drew, 1994, 194.

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House staff members had similar reactions: “because it was Hillary’s project, everyone was nervous about criticizing it.”50 Even chief of staff Leon Panetta would not offer the benefit of his counsel on health care because “The First Lady did what she always did; she acted as if anyone who disagreed with her didn’t know what they were talking about, and I said to myself, “Okay, I’m recusing myself from this issue.”51 Cabinet members fared little better: an unidentified Cabinet member told Haynes Johnson and David Broder, “You make your point once to the President’s wife, and if it is not accepted, you don’t press it.”52 Even HHS Secretary Donna Shalala, who had enjoyed a prior peer relationship with Mrs. Clinton, found this to be true: a colleague of Shalala’s said, “Donna learned that there were certain subjects you didn’t raise.”53 Many of the senior White House staff and Cabinet members on President Clinton’s “economic team” also had serious doubts about the heavily bureaucratic, costly health care plan Mrs. Clinton’s task force was assembling,54 but when they raised any questions, “the First Lady would, with cold fury, tell the questioner to stuff it; their plan was the plan.” The President “sat quietly as the First Lady bludgeoned respected members of the Administration, like Lloyd Bentsen, Bob Rubin, and Leon Panetta—into silence.”55 In sum, the First Lady’s direct, executive involvement had a telling effect upon the whole health care policy process: as Gergen relates, “At health care meetings that summer, the economics group started to muffle their voices…In one meeting in the cabinet room, only Laura Tyson, head of the Council of Economic Advisers, challenged the First Lady on cost projections. The rest of us shuffled our feet, and held Laura’s coat. No need to say who prevailed.”56 In the words of another insider, “The person who’s in charge shouldn’t sleep with the President, because if you sleep with the President, nobody is going to tell you the truth.”57

CONCLUSION The documentary evidence found in the files of the White House Health Care InterDepartmental Working Groups, though far from complete because related files have yet to be made public, is less supportive of the interpretation put forth during 2003 by the Clintons than it is of the more critical depiction found in the accounts of participants such as Gergen, Stephanopoulus, and Blumenthal; and of observers such as Drew, Klein, and Johnson and Broder. Although Skocpol has defended the Clintons’ health care policy formulation process as not so different from that which produced the New Deal’s Social Security legislation in

50

Ibid., 195. Quoted in Klein, 2002, 121. 52 Johnson & Broder, 1996, 176. 53 Drew, 1994, 193; see also Gergen, 2000, 300-01. 54 Drew, 1994, 194-95; Klein, 2002, 121; Gergen, 2000, 301-03. 55 Klein, 2002, 121. 56 Gergen, 2000, 301. 57 Johnson & Broder, 1996, 101. 51

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1934-35; in both cases, administration officials, and selected policy experts made decisions about major policy options without public hearings.58 It is self-evident that the policy-making process employed in 1993 was not nearly as inclusive as the benefits it intended to create and distribute. Although such a democratic irony might pass unchallenged in an age when fourteen million were out of work, and the media kept the president’s physical condition and private life from public view; it was certain to draw fire during our own hyper-mediated and hyper-pluralistic age, as surely the Clintons should have known after what they had endured to reach the White House.

ACKNOWLEDGEMENTS The author would like to thank Skip Rutherford of the Clinton Presidential Foundation and Emily Robison, Supervisory Archivist, and the staff of the Clinton Presidential Materials Project for facilitating this early research.

58

Skocpol, 1996, 14.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 63-74

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

THE INFLUENCE OF FIRST LADIES ON MENTAL HEALTH POLICY

Jerome L. Short, Colleen J. Shogan, and Nicole M. Owings ABSTRACT Due to their personal and family experiences with mental illness, religious beliefs, formal education, socialization as caregivers, earlier success in changing state policies, and political ideology; several first ladies have chosen to influence federal mental health policy. The political advocacy of first ladies, and their preferred policies reflect presidential preferences, but over time they have become more autonomous, and systematic in their work as their accepted political roles multiply. This article traces the development of federal mental health policy, and the contribution of six first ladies from Eleanor Roosevelt to Laura Bush.

INTRODUCTION First ladies have engaged in many different social roles during the history of the United States. They have served as supportive spouses, hosted social events in the White House, overseen renovations of the White House, campaigned for their husbands, edited presidential speeches, advised on cabinet appointments, championed important social causes, represented 1 the president in foreign affairs, and developed and influenced social policy. First ladies have performed all of these roles without being elected, appointed, paid, or even mentioned in the Constitution. The role of the first lady reflects the status and concerns of women in the United States. For the past century, first ladies have attempted to improve the quality of life for children and families through their efforts to increase the availability and quality of mental health services. The Surgeon General’s report on mental health estimates that 21 percent of all Americans 2 have experienced a mental disorder during the past year. The Diagnostic and Statistical Manual of Mental Disorders (4th edition-text revision; DSM-IV-TR) describes more than 200 1

Watson, R. P. (2000). The presidents' wives: Reassessing the office of the first lady. Boulder, CO: Lynne Rienner Publishers. 2 U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Bethesda, MD: U.S. Public Health Service.

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specific diagnostic categories for mental disorders that are separate from any diagnoses of physical disorder.3 In this article, mental health will refer to the successful treatment of psychiatric disorders, the reduction of psychological symptoms, and the enhancement of self-esteem, life satisfaction, and quality of life. Since approximately 60 million Americans experience mental disorders, and many friends and family members serve as caregivers, it is incumbent that the executive branch promotes policies designed to address mental disorders. Next, we examine the efforts over the past century of six first ladies from three Democratic, and three Republican administrations to influence federal mental health policy, and how this policy has changed over recent years.

ELEANOR ROOSEVELT: COMPASSIONATE LIBERALISM Eleanor Roosevelt took on a variety of issues as they arose, most of them growing out of her pre-White House career as a social and political activist, and many coinciding with New Deal programs. Her interest in mental health services started with her own experience of growing up in a family with an alcoholic father, and visiting an uncle who suffered from mental illness. In 1913, Franklin Roosevelt was appointed Assistant Secretary of the Navy, and he and Eleanor moved to Washington, DC. During World War I, Eleanor was a Red Cross volunteer, and worked in a canteen for soldiers, organized knitting projects to provide clothing, and regularly visited soldiers in military hospitals. In her autobiography, Mrs. Roosevelt described that once a week she visited the Federal Naval Hospital and took flowers, cigarettes, and other items that might cheer the men who had returned from the war overseas.4 The naval hospital filled rapidly, and one building was taken over at St. Elizabeth's Hospital in Washington, DC for the so-called “shell-shocked” patients. Some of them recovered, but others remained permanently hospitalized. Many of these veterans were kept in padded cells or in some kind of confinement. At this time, St. Elizabeth's was the only federal hospital for the “insane” in the country. The hospital was understaffed, attendants were poorly paid, and Eleanor observed that many distressed patients gazed at her from behind bars, and were restricted to walking up and down on enclosed porches. Distressed by these sights, Mrs. Roosevelt persuaded the Secretary of the Interior, Franklin Lane, to investigate the living conditions at the hospital. Lane appointed a committee that later appeared before Congress, and asked for, and received, increased congressional funding for St. Elizabeth's Hospital; and for a time, it became a model for treatment of persons with psychological disorders. During the 1920s in New York, Eleanor began to focus more on improving the day-today quality of life for average Americans. She joined a variety of women's associations, and spent a great deal of time examining legislation and committee reports from Congress. She outlined strategies to lobby for legislation that would expand the rights of women and children. Mrs. Roosevelt testified before the New York Senate committees on behalf of protective labor legislation and criticized her husband's plan for unemployment insurance. 3

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC. 4 Roosevelt, E. (1961). The autobiography of Eleanor Roosevelt. New York: Harper & Brothers.

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After Franklin Roosevelt became president in 1933, Eleanor accepted an offer for a monthly column from Women's Home Companion, and donated her monthly $1,000 fee to charity. She asked her readers to share problems with her that puzzled or saddened them. By January 1934, 300,000 Americans had responded to her request. Eleanor learned about the squalid living conditions of coal miners in West Virginia, and met with the Secretary of the Interior, Harold Ickes, to argue that the National Industrial Recovery Act could help address the community's problems. She supported other programs to reduce poverty and advocated the hiring of women, African Americans, and liberals within federal agencies. Eleanor wanted programs to focus more on dealing with the distress of poverty, and not just on material needs. For example, she pressured Harry Hopkins, head of the Federal Emergency Relief Administration, to develop a youth program that would provide vocational guidance and education rather than military training.5 She argued that the specific problems facing youths needed to be addressed, but only in a way that fostered a sense of self-worth. By providing job skills and education, she hoped that the new National Youth Administration (NYA) would foster a sense of civic awareness that, in turn, would promote a commitment to social justice. In the White House, Eleanor revolutionized the role of First Lady. She was the first (and only) first lady to hold regular press conferences, write a daily newspaper column, publish books and articles, travel the nation on speaking tours, chair national conferences in the White House, address national conventions of social reform organizations, give a keynote address at her party's presidential convention, represent her nation abroad, travel across battlefields, and direct a governmental agency.6 After Franklin died, Eleanor was urged to run for governor or senator from New York, but declined. President Truman appointed her to the U.S. delegation to the United Nations, and she oversaw the drafting and unanimous passage of the Universal Declaration of Human Rights. She also served on the national board of directors for the NAACP, CORE, and other major civil rights organizations. One of her final efforts was to pressure John Kennedy to make concessions to civil rights in his platform before she would campaign for him. One could argue that Mrs. Roosevelt's compassion for less fortunate Americans had motivated a variety of efforts during her lifetime to establish governmental and societal institutions that helped support people, and reduce their psychological distress. The next several first ladies until Betty Ford would limit their activities primarily to the roles of wife, mother, sometime campaigner, social hostess, and caretaker of the White House.

MENTAL HEALTH POLICY REFORMS FROM THE 1940S TO 1970S After World War II, the Veteran's Administration was created to care for the unprecedented number of veterans with medical and psychological disorders. Also, the National Institute of Mental Health (NIMH) was established to coordinate funding for mental 5

Black, A. M. (1996). (Anna) Eleanor Roosevelt. In L. L. Gould (ed.), American first ladies: Their lives and their legacy (pp. 422-448). New York: Garland. 6 Ibid.

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health research and training. In 1955, Congress created the Joint Commission on Mental Illness and Mental Health that developed a comprehensive mental health plan. The committee reported its plan in 1961 after President Kennedy took office, and recommended that instead of constructing large mental hospitals, the government should provide a flexible array of services for the mentally ill in the patients' communities. Part of the social problem of mental illness was that treatment disrupted patients' lives by taking them from their communities where family members and neighbors might help them to resume normal lives. As a response to the Joint Commission report, the NIMH proposed a series of community mental health centers. With the support of President Kennedy, who was personally interested in mental health because of his sister Rosemary Kennedy's mental retardation, and through timely advocacy by members of Congress, the NIMH, and the National Mental Health Association, Congress passed the Community Mental Health Centers (CMHC) Act in 1963. The mandate given CMHCs was different than that of traditional psychiatric hospitals, and it included care for persons with mental disorders in the community, crisis intervention, prevention, and consultation with other community agencies.7 The community mental health movement in the United States evolved into a political as well as a therapeutic endeavor that attempted to reach many underserved and underprivileged groups. Those active in the movement conceptualized psychological disorders in the context of poverty, and other environmental stressors; and some influential psychologists advocated 8 the view that mental illness was not due to individual weakness or immorality. This was essentially a view that those with mental illness were often as much victims as blameworthy individuals. The policymakers who supported community mental health legislation were generally liberal Democrats and, together with mental health professionals and patients’ rights activists, made the movement more social change oriented. With its emphasis on benevolent, rather than punitive, measures for social control, community mental health legislation and programs became an incarnation of the Progressive Era.9 Although spending money and passing laws are ways for political leaders to make claims about solving social problems, they can also use rhetoric and imagery connected to these problems to unite political coalitions. In the 1960s, the federal government supported community mental health not only by providing funds but also by legitimating the movement's approach and concerns.10 Presidents Kennedy and Johnson were vocal in their support for community mental health as part of their vision of a New Frontier and a Great Society. Their rhetoric and policies were centered on the creation of a better society, in which more people, such as those with problems in living, would be included. They avoided claiming that individual character defects were to blame for social ills.

7

Levine, M. (1981). The history and politics of community mental health. New York: Oxford University Press. Humphreys, K. and Rappaport, J. (1995). From the community mental health movement to the war on drugs: A study in the definition of social problems. American Psychologist, 48(8), 892-901. 9 Rothman, D. J. (1981). Conscience and convenience: The asylum and its alternatives in progressive America. Boston: Little, Brown. 10 Humphreys and Rapport. 8

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BETTY FORD: THE PERSONAL IS POLITICAL Following several Democratic presidents' efforts to establish mental health treatment and research institutions; a Republican first lady, Betty Ford, influenced the use of mental health services in a more personal way. While Gerald Ford was President, Betty spent many hours in the Washington Hospital for Sick Children, and comforted disabled and emotionally disturbed children. She also supported efforts to eliminate the abuse of older people, and improve nursing homes for the poor and ailing elderly. Mrs. Ford campaigned, and sought support for these causes among people involved in the arts and humanities.11 One event became a turning point in Betty Ford's life, and changed her perceived capacity to influence others. In September 1974, a month after entering the White House, she was diagnosed with breast cancer. Despite the very private nature of her condition, Mrs. Ford made an important decision that would have a tremendous social impact: she decided to make her condition known to the public. She discussed the uncomfortable issue of her breast cancer diagnosis and mastectomy with the media. According to an article in Ms. magazine, Betty Ford said that "there had been so much cover-up during Watergate that we wanted to be sure there would be no cover-up in the Ford Administration."12 By disclosing her breast cancer and mastectomy, Betty Ford was personally responsible for increased public awareness of cancer related issues, and for the reduction of stigma surrounding cancer. After Mrs. Ford went public to alert as many women as possible to the benefits of early detection, millions of women scheduled appointments at breast cancer clinics across the country. Among the lives saved was Happy Rockefeller, the vice president's wife, who underwent a mastectomy shortly after Betty did. The First Lady received over 55,000 cards and letters from women who had mastectomies or who were encouraged by her experience to get check-ups. For the first time, Mrs. Ford truly understood the extraordinary power she held.13 Following Gerald Ford's defeat in 1976, and the Fords return to California, Betty became dependent on pain-killing pills for her osteoarthritis, and on tranquilizers and alcohol for her anxiety. Her family became increasingly concerned about her erratic behavior, and her deteriorating physical and psychological health. In early 1978, family members persuaded her to check into the Alcohol and Drug Rehabilitation Service of the Long Beach Naval Hospital. Doctors encouraged her to tell the public about her substance abuse, which she refused to do at first, fearing much embarrassment would befall her husband and family.14 Eventually, she realized that disclosing her alcoholism could help others to seek diagnosis and treatment, as had occurred after her disclosure of her cancer and mastectomy four years previously. After her successful treatment, she became an advocate for support of similar programs. With the cooperation of her family, friends, and medical professionals; she helped found the 11

Davis, K. L. and Refkind, L. J. (2002). The role of first ladies in healthcare reform. White House Studies, 2(3), 287-298. 12 “Betty Ford: Today Still Speaking Out," Ms. (April 1984), p. 41 13 Ashley, J. S. (2001). The social and political influence of Betty Ford: Betty Bloomer blossoms. White House Studies, 1(1), 101-109. 14 Davis and Refkind

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Betty Ford Center for Drug and Alcohol Rehabilitation, which opened in 1982 in Rancho Mirage, California. For more than 20 years, the program has treated celebrities and ordinary citizens with drug and alcohol problems. The larger impact of her efforts was to help break down the stigma associated with psychological disorders by speaking out about her anxiety and substance abuse, obtaining professional help, and making treatment more widely available to others. Mrs. Ford's advocacy for substance abuse treatment was consistent with a Republican philosophy of viewing problems as occurring within individuals, and expecting individuals to help themselves, and mobilize their local communities to generate funding for mental health treatment.

ROSALYNN CARTER: POLITICAL LEADER OF SYSTEMIC CHANGE Rosalynn Carter, as part of a Democratic administration, chose to take a more systemic approach to mental health policy. Mrs. Carter has been a visible, active leader in the mental health field for more than 30 years, and she has also been an enthusiastic supporter of the Special Olympics. As First Lady of Georgia, and of the United States; and in the years since, Mrs. Carter has pushed for reform on a number of mental health issues such as reducing stigma, parity for treatment options, payment by insurance providers, increased brain related research, better access to improved mental health services, and early intervention for children. In her book, Helping Someone with Mental Illness; Rosalynn reported that, during her childhood, she knew one of Jimmy’s cousins who was in and out of the state mental hospital in Georgia, and that her visits to the hospital had a deep impression on her.15 Also, her early social life focused on church activities with her Lutheran grandmother, Baptist grandfather, and Methodist parents that encouraged service to less fortunate others. Mrs. Carter's public service commitment to mental health issues began when her husband was Governor of Georgia from 1971 until 1974. While she was campaigning, Rosalynn learned about the serious deficiencies in state mental health services. When she became the First Lady of Georgia, she served as a volunteer at a mental health facility. Also, her husband appointed her to serve as a member of the governor's commission to improve services for the mentally and emotionally handicapped. The commission compiled a report that was sharply critical of mental health services, and outlined a comprehensive care plan to shift the treatment from large institutions to community mental health centers. Over the next three years, the number of community mental health centers grew from 23 to 134, and the mental health programs became models for other states.16 Mrs. Carter focused on mental health as her central policy concern while First Lady of Georgia, and she expanded her involvement as First Lady of the nation. During the 1976 presidential campaign, she stated, "It has been fifteen years since anyone has even done a report on mental health care, and the programs have become so splintered that it's time we look at all of them, and give some direction to national health care for the mentally ill."17 15

Carter, R., and Golant, S. K. (1998). Helping someone with mental illness. New York: Times Books. Smith, K. B. (1996). (Eleanor) Rosalynn (Smith) Carter. In L. L. Gould (ed.), American first ladies: Their lives and their legacy (pp. 556-582). New York: Garland. 17 Carter, R. (1984). First lady from Plains. Boston: Houghton Mifflin, p. 140. 16

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As President, Jimmy Carter appointed Rosalynn the honorary chairperson of the President's Commission on Mental Health. President Carter gave the commission one year to conduct a study of the nation’s mental health system, and prepare a report. In 1979, only a small percentage of Medicare and Medicaid funds were available for mental health, and only one-half to one percent of the federal budget was dedicated to research in mental health. The report included a list of 117 recommendations for improving mental health care, ranging from mental health insurance to community mental health centers, and addressed rural mental health needs. Once the report was completed, the task of the administration became the implementation of the commission's recommendations. For the recommendations that did not require congressional action, President Carter asked government agencies affected by the proposed changes to develop timetables and plans to implement the recommendations. The remaining proposals were written into legislation in the form of the Mental Health Systems Act, and President Carter submitted it to Congress in May 1979. As the legislation made its way through Congress, Rosalynn worked to gain support for the bill from interest groups and healthcare organizations.18 In February, 1979, Mrs. Carter also testified on behalf of the bill before the Senate subcommittee on Human Resources that was responsible for the legislation. She followed Eleanor Roosevelt as the second first lady to testify before Congress. In September 1980, the Mental Health Systems Act was enacted and funded by Congress. It was the first major reform of national mental health programs since 1963. However, most of the funding for the act was withdrawn within a month of President Reagan's inauguration in January 1981. The changes in mental health policy that did not require congressional action were not easily reversed, and remained in effect. After returning to Georgia, President and Mrs.Carter formed The Carter Center. Mrs. Carter's advocacy goals provided the framework for the Center's Mental Health Program, formed in 1991. She led the annual Rosalynn Carter Symposium on Mental Health Policy, a meeting of national mental health leaders, and led the development of the Carter Center Mental Health Task Force. In December 2000, the Program, as co-sponsor, convened its first conference on the international level, the Inaugural World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders. In addition, Mrs. Carter has chaired the World Federation for Mental Health's (WFMH) International Committee of Women Leaders for Mental Health since its establishment in 1992. In 1992, to focus attention on the plight of those suffering from mental illnesses, WFMH designated October 10th as World Mental Health Day. To increase awareness of this special day, WFMH created an International Committee of First Ladies for Mental Health, and Rosalynn was the chairperson. To expand the scope of committee involvement to include not only first ladies, but also female members of royal families, and heads of state; the name was recently amended to International Women Leaders for Mental Health: A Committee of the World Federation for Mental Health Consisting of Royalty, Heads of State, and First Ladies. Working together with mental health leaders of various countries provides an important opportunity to produce positive change for citizens with mental disorders.

18

Chanley, V. A. (2001). The first lady as presidential advisor, policy advocate, and surrogate: Rosalynn Carter and the political role of the first lady. White House Studies, 1(4), 549-561.

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NANCY REAGAN: INDIVIDUAL CHANGE WITHOUT GOVERNMENT PROGRAMS In 1982, First Lady Nancy Reagan became involved in substance abuse prevention with the famous three-word command that was emblematic of a more conservative view of the nature of substance abuse problems, “Just say no.” She traveled around the country visiting substance abuse treatment centers and schools, and spoke about the seriousness of the drug problem in the United States. She delivered numerous speeches on the issues of drugs and drug addiction, attended countless anti-drug conferences, appeared on television specials regarding drug abuse, and appeared in a televised documentary, "The Chemical People" shown on PBS. Mrs. Reagan also guest starred on the television show "Different Strokes" in a cameo role for one episode discouraging drug use among young people. She hosted 18 foreign first ladies at the First Ladies Conference on Drug Abuse at the United Nations. By May 1987, Nancy had traveled to 60 cities in 30 states and seven foreign countries for antidrug awareness.19 Mrs. Reagan's public statements reflected a view of substance abuse resulting from an internal defect in the abuser. By advancing such a view of substance abuse, the Reagan administration took advantage of the claims made about substance abuse throughout American history. Historically, moral and cultural conservatives have defined the social problem of substance abuse. In politically conservative times explanations for problems are often intra-individual; this approach deflects criticism of and attributions of responsibility to government officials. The treatments that follow from such a model are programs that focus on spiritual enlightenment, punishment by moral condemnation or imprisonment, psychotherapy, and biological treatment. Administrations can adopt superficially progressive programs to help those with internal defects, but, in essence, such policies are conservative in that they accept the claim that the government has minimal responsibility in relieving the problems of individuals.20 Many social programs, including community mental health, were curtailed in the ReaganBush era, but the public substance abuse treatment network increased in size. Policymakers in the Reagan administration replaced a problem that had historically been defined by progressives with one that had historically been defined by social conservatives. The federal government reduced its financial support of community mental health centers, and related programs that emphasized the social and environmental causes of their clients' problems. A new group of political activists in public substance abuse agencies, often located in the poorer areas of large cities, emphasized the need for individuals to overcome moral, spiritual, and physical defects to stop substance abuse. Although the community mental health movement was broader than any one government policy, federally funded community mental health centers became the visible, institutional embodiment of the government’s values and goals. After two decades of strong support, in 1981 the government began scaling back funding to community mental health centers beyond what had originally been planned. Under the Omnibus Budget Reconciliation Act of 1981 (PL 19 20

Davis and Refkind. Davis and Refkind.

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97-35), the Reagan administration reduced the federal role in community mental health, repealed Carter's Mental Health Systems Act, and replaced direct federal funding for community mental health with smaller block grants to the states.21 At this time, only 750 of the envisioned 2,000 community mental health centers were in place.22 The financial strain left these centers fighting for survival.23 Although the Reagan administration curtailed funds for community mental health centers, it pumped increasing amounts of money into substance abuse treatment and prevention programs. From 1981-1991, funding for federal drug programs increased by 679 percent. In contrast, total federal outlays only grew 95 percent over the same period. The Reagan administration also created the Office of Substance Abuse Prevention, the Office of Treatment Improvement, and the post of drug czar. From 1989 to 1993, the Bush administration continued many of the same drug fighting policies of the Reagan administration. In 1991, President Bush proposed to appropriate $1.674 billion for substance abuse treatment, and $1.396 billion for substance abuse prevention, which included hundreds of millions of dollars for substance abuse research grants.24 However, within three weeks of taking office in 1993, President Clinton eliminated the majority of jobs at the Office of National Drug Control Policy.

HILLARY CLINTON: SUPPORT FROM THE VILLAGE AND THE GOVERNMENT Hillary Clinton's advocacy for mental health care programs has its roots in her childhood, and her formal education. In her 2003 autobiography, Living History, she described her devout Methodist upbringing that advocated serving others in need.25 Her church activities led to meetings with black and Hispanic teenagers in downtown Chicago, and an awareness of the effects of poverty and prejudice on the self-esteem of less-privileged peers. During her law school years at Yale University, she helped draft guidelines for the treatment of abused children at Yale-New Haven Hospital, and observed distressed children being treated at the Yale Child Study Center. As First Lady of Arkansas, Hillary focused on improving parenting instruction with the introduction of the Home Instruction Program for Preschool Youngsters (HIPPY). Also, she founded the Arkansas Advocates for Children and Families, and served as chair of the Arkansas Education Standards Committee. Shortly after Bill Clinton's inauguration in 1993, Hillary was named to head the President's Task Force on National Health Care Reform. She was following in the path of earlier Democratic first ladies: Eleanor Roosevelt had served as Assistant Director of Civilian Defense, and Rosalynn Carter had been named Honorary Chair of the President's Commission on Mental Health. However, neither Mrs. Roosevelt nor Mrs. Carter had the staff, funds, 21

Omnibus Budget Reconciliation Act of 1981, Public Law 97-35. Mosher, L. R., & Burti, L. (1989). Community mental health: Principles and practice. New York: Norton. 23 Goplerud, E. N., Walfish, S., & Apsey, M. O. (1983). Surviving cutbacks in community mental health: Seventyseven action strategies. Community Mental Health Journal, 19, 62–76. 24 Humphreys and Rappaport. 22

25

Clinton, H. R. (2003). Living History. New York: Simon & Schuster.

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formal training, or political clout of Mrs. Clinton. Unfortunately for Mrs. Clinton, her husband’s political opponents quickly challenged her health care reforms. To achieve her goals, Hillary had closed meetings to the media and the public, causing frustration and anger. The Association of American Physicians and Surgeons brought suit in federal court to open the meetings. A federal judge ruled that the task force was guilty of misconduct in withholding documents; later, however, the United States Court of Appeals for the District of Columbia held that Mrs. Clinton was a "de facto officer or employee" of the government, and that the Task Force was not obligated to open its hearings.26 When the Task Force unveiled its sweeping, controversial reform plan, a variety of physician’s groups, drug companies, and insurance companies lobbied Congress to stop it. Several senators offered compromises that might have won the support of both the Democrats and Republicans, but the First Lady remained unyielding, particularly on the provision of universal coverage. After Democratic Senator Daniel Patrick Moynihan began to criticize the health care cost estimates as “fantasy” numbers, the health care plan was soundly defeated in September 1994.27 However, some of the elements of the program, such as parity between medical and mental health treatment, were later incorporated in the insurance coverage of federal workers. For a time, Mrs. Clinton adopted a more traditional First Lady role, addressing women’s groups and conferences, and touring Asia with her daughter Chelsea. She started a weekly syndicated newspaper column, Talking It Over, like Eleanor Roosevelt had done 60 years earlier. In 1995, she attended the United Nations Fourth World Conference of women in Beijing, China. Hillary criticized the governments of China, India, Bosnia, Iran, and others, for their poor human rights records, especially the lack of women's rights. In 1996, she published It Takes a Village, a book that described her parenting experiences, and reviewed a variety of psychological research on raising children, and improving community programs to prevent mental health problems.28 Following her years in the White House, Mrs. Clinton has earned another opportunity to affect mental health policy with her election to the Senate from New York in 2000. Aspects of the Clinton health care plan are part of the campaign platforms for several Democratic presidential candidates for the 2004 election. The Second Lady, Tipper Gore, also served as a mental health advisor in the Clinton Administration. Mrs. Gore joined the Task Force on Mental Health Benefits in 1994, and pressed for parity between mental and physical health benefits, and supported projects that helped decrease the stigma of mental illness. Her knowledge of mental health policy stemmed from her academic work in earning a master's degree in psychology from George Peabody College at Vanderbilt University. In addition, Tipper revealed her own treatment for depression, and helped publicize the experiences of others who were treated for mental illness during the first ever White House Conference on Mental Health that she chaired in 1999.

26

Gutin, M. (2001). Hillary Clinton. In R. P. Watson (ed.), Laura Bush: the report to the first lady (pp. 165-169). Huntington, N.Y.: Nova History Publications. 27 Clinton. 28 Clinton, H. R. (1996). It takes a village: and other lessons children teach us. New York: Simon & Schuster.

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LAURA BUSH: COMPASSIONATE CONSERVATISM The current First Lady, Laura Bush, has occasionally focused on the mental health of children, starting with her efforts in the 1990s as First Lady of Texas. She promoted a program for abused and neglected children called Greater Texas Community Partners run by the state Department of Child Protective services. The agency set up volunteer-run "Rainbow Rooms" where child-abuse caseworkers could get free clothes, diapers, formula, and other supplies for children. The statewide program spread to more than seventy cities.29 Laura also advocated for an Adopt-A-Caseworker program in which child abuse caseworkers were supported by a business, church, or school with material supplies, and appreciation for their work. Mrs. Bush's policy efforts from the White House have included helping to organize a summit on early childhood cognitive development in July 2001. However, the emphasis of the summit was preparing children for school rather than dealing with developmental disorders. Mrs. Bush has also influenced children’s mental health by her efforts to provide support and reassurance to children after the terrorist attacks of September 11, 2001. She wrote two letters, one for elementary school students, and one for middle and high school students that were sent to every state school superintendent. The letters explained that family, teachers, and school counselors were available to listen and talk about the recent national tragedy. A week after the attacks, Mrs. Bush appeared on the Oprah Show speaking on ways to help children cope with the stressful events, and their consequent anxiety and sadness. President George W. Bush has initiated another consideration of federal mental health policy. President Bush established the New Freedom Commission on Mental Health in April 2002 as part of his initiative to eliminate inequality for Americans with disabilities; charging it with the first comprehensive study of the nation's public and private mental health service delivery system since President Carter's 1978 Mental Health Commission, 25 years ago. The Commission's Report, released in 2003, declared the existing system a fragmented, inefficient maze of private, federal, state, and local government programs with scattered responsibility for services that frustrates both people with mental disorders and providers of mental health care, and called for dramatic reform at all levels of the mental health system.30 However, no new funding is currently dedicated to this reform plan. The Commission’s Report recommends parity of insurance coverage between the costs of mental and physical health services. However, differences may exist in how Republicans and Democrats define parity, and in how they allocate financial resources needed for parity. Although conservatives tend to focus on the individual and biological causes of social problems, liberals often accept enviromental and social group explanations. Thus Republican legislators may be more likely to limit insurance coverage to the most severe mental disorders that are generally treated with medication in an effort to minimize governmental expenditures. One recent estimate is that approximately 5 million people suffer from severe mental illness.31 29

Felix, A. (2002). Laura, America's first lady, first mother. Avon, MA: Adams Media Corporation. President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. 31 Health care reform for Americans with severe mental illnesses: Report of the National Advisory Mental Health Council. (1993). American Journal of Psychiatry, 150(10), 1447-1465. 30

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In contrast, Democratic legislators may be more likely to extend mental health insurance coverage in the form of comprehensive services including medication, psychotherapy, and community support services to many more of the approximately 60 million who suffer from any of the more than 200 diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders.

CONCLUSION First ladies have contributed substantially to federal mental health policy, and the availability and use of mental health services. Many of the recent first ladies of the White House were formerly first ladies at the state level. Their activity at the state level served as a reliable predictor of their involvement with federal mental health policy. Personal and family experiences with mental illness elicited aspects of the caregiving role for most of the first ladies described here. Also, the Christian ethic of serving the less fortunate has provided motivation for government and volunteer efforts to improve access to mental health. The recent efforts of Hillary Clinton and Tipper Gore, both of whom have graduate degrees, show the importance of more specialized education in understanding and developing federal mental health policy. In general, Democratic first ladies have played a more active role in mental health policy than Republican first ladies. This partisan divergence can be explained partially by their distinct ideological philosophies about both personal responsibility, and whether the federal government should attempt to provide funding for comprehensive mental health services. At this point, our preliminary observations about partisan divergence must remain speculative because there are not enough activist first ladies in American history to facilitate a robust comparative study. However, the influence of first ladies in mental health policy has accelerated, and become more systematic over the past century. Since the public policy component of the first lady’s job will likely continue to grow, future scholars will be able to draw concrete conclusions concerning partisan differences between Republican and Democratic first ladies. The role of first ladies in the policymaking process is part of a research agenda that seeks to study the Office of the First Lady as a political institution. This essay argued that first ladies have been instrumental in effecting change in mental health policy. In addition to giving due credit to first ladies, who have often worked without significant accolades, or any monetary compensation, research on their role as policymakers also contributes to presidential scholarship. First ladies are now firmly part of their husband’s electoral coalition. Polls regularly measure the popularity of first ladies, and both national party organizations measure the public’s approval of “would-be” first ladies during a presidential campaign. Therefore, the policy issues that first ladies pursue can have a measurable effect on the popularity of a president’s administration. The time has come for scholars to monitor which policy issues first ladies choose, how they enact their proposals, and whether divergent approaches to the office influence executive governance.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 75-89

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

THE GEORGE W. BUSH PRESIDENTIAL TRANSITION: THE DISCONNECT BETWEEN POLITICS AND POLICY

Anthony J. Eksterowicz and Glenn P. Hastedt ABSTRACT The first months of a new presidency are a unique time in American politics. It is a period of great presidential activism, with appointments and policy initiatives announced on almost a daily basis. It is a “honeymoon” period, when the president’s relationships with Congress and the media are at least cordial if not deferential. It is a period when campaign promises come due and domestic politics are on everyone’s mind. It can also be a period of frustration as newly elected presidents struggle with recalcitrant staffs and large unfamiliar bureaucracies. This paper examines the transition of the Forty-third president, George W. Bush, noting problems experienced and offering lessons.

INTRODUCTION Newly elected presidents almost always feel frustrated and inadequate in their dealings with the Congress. Washington is unfamiliar territory for presidents, especially if their only experience was at the gubernatorial level of government. The key to a successful first year in the White House is advanced planning and learning during the transition period from one administration to another. This period lasts eleven weeks just seventy-seven days. It is a frightfully short period of time to adjust to the Washington culture. Yet failure to do so will inevitably result in policy failures for the president. What if the elected president had to survive a strong primary challenge and then engage his opponent in a razor thin election? Suppose further that the election was not over on Election Day and continued during the transition phase. Suppose a newly elected president lost more than half of the transition to this contested election. This was the plight of George W. Bush after December 13, 2000. The 2000 presidential election represented a unique challenge for transition efforts. Due to the uncertainty of the electoral vote open transition efforts were highly criticized. For example, President Bush sought to create an image of leadership by openly discussing his

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possible cabinet choices in the days immediately following the undecided election – discussions criticized by the media as premature.1 This article will examine the effects of the short transition upon George W. Bush’s policy agenda. It is the position here that certain dysfunctions can be traced to the transition period which resulted in a confusion of politics from policy. We will first present a framework for analyzing intra-party presidential transitions. Second, we briefly describe the complexity of the 2000 election and its impact upon transition efforts. Third, we assess a few impacts upon various Bush Administration policies. Fourth, we present a case study of the effects of this transition upon Iraq policy. Finally we offer some suggestions for remediating these problems traceable to a shortened or normal transition period.

PRESIDENTIAL TRANSITIONS: A FRAMEWORK FOR ANALYSIS One way of judging presidential transition is by assessing the quality and quantity of presidential appointees in place early in a presidential administration. While appointments are important (and we shall assess the Bush II Administration’s progress in this area) they do not tell the entire story of a successful transition. We need a framework that can connect appointments to policy. Other factors can influence and even overwhelm presidential administrations. The late Richard Neustadt has warned of the perils facing incoming presidential administrations in their transition phase.2 Most first-term presidents are new to the presidential policy process; thus they are prone to be caught by surprise by the events in the domestic or foreign policy realm. The Chinese forced landing of an American spy plane is such an example early in the Bush II Administration. This is especially the case with successful presidential candidates who have campaigned as Washington outsiders. Second, most presidents will face pressures to act, perhaps in haste, to developing problems. New administrations face the pressure of time to achieve policy accomplishments with limited political capital. In fact, as Paul Light has warned, presidents must push their domestic policy agenda through the Congress before losing precious political capital during their first year in office.3 Third, most presidents will face the problem of hubris, or the feeling that they or their administration know best how to organize and respond to policy problems.4 This feeling of hubris can lead to a fourth problem of naiveté concerning the Washington policy and political process. New presidential administrations invariably are affected by their campaign victory. These administrations were victorious and thus tend to think that their answers to policy problems are correct ones. However, new presidents who have campaigned as Washington outsiders do not fully comprehend how the Washington establishment operates and this complicates their tasks. These administrations need to learn the Washington policy process; however, naiveté and hubris act as barriers to the learning process. 1

For example, William Schneider on CNN’s Inside Politics, November 8, 2000; and Brian McGrory, “Both Rivals Failing Test,” The Boston Globe, November 14, 2000. 2 Richard E. Neustadt, “Presidential Transitions: Are the Risks Rising,” Miller Center Journal, 1 (1994:2. 3 Paul C. Light, The President’s Agenda: Domestic Policy Choices from Kennedy to Carter (Baltimore: John Hopkins University Press), pp. 1-62. 4 Neustadt, “Presidential Transitions: Are the Risks Rising?” p. 4.

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All of these problems can be found in each modern presidential administration. Furthermore, W. David Clinton has listed the following as factors in the presidential transition process: the outgoing president, the incoming president, the career services, the Congress, and foreign states.5 Each of these factors can complicate the transition process, especially if the new president is unfamiliar with the Washington policy or political process. Newness, haste, hubris, and naiveté all combine to complicate a new president’s transition process. These factors have an impact on a president’s understanding of the Washington political and policy process. Ignorance concerning key elements of the political or policy process can cripple key items in a president’s domestic or foreign policy agenda. It can lead to proposing flawed or contradictory policies. It can damage political relationships so necessary for presidential success. Examples abound from various presidential administrations. From President Carter’s insistence upon congressional authority for a government reorganization plan before Congress had elected its leaders,6 to President Clinton’s failed British thermal unit tax proposal.7 While an understanding of the political and policy process is crucial for presidential success, learning about the policy and political process must occur early to increase presidential first year success. Suppose a president’s opportunities for learning during a transition phase are cut by more than half. In addition this particular president elect is largely considered a political novice due to his first successful election and re-election to the Texas governorship. The President in question, George W. Bush, also campaigned as a Washington outsider. The potential for disastrous domestic and foreign policy recipes were ever present. We now turn to a brief description of the 2000 presidential and the Bush transition efforts.

THE 2000 PRESIDENTIAL ELECTION AND BUSH TRANSITION EFFORTS The Bush 2000 presidential campaign faced hotly contested races and pressures from John McCain and Albert Gore during the primaries, general election and post election phase of the election. Candidate Bush had to first remove McCain as an impediment standing in his way but while Bush was successful, McCain essentially forced Bush to spend tremendous sums of campaign money to ensure victory. This made the general election between Gore and Bush more financially competitive. While Political Scientists predicted a Gore victory of three to five percentage points based upon their economic election modeling8 the daily tracking polls continued to indicate a close race.9 Both candidates pursued strategies of shoring up their base then moving to the political center. Perhaps they both succeeded given the close nature of the race with Gore 5

W. David Clinton and Daniel G. Lang, eds., Papers on Presidential Transition and Foreign Policy Volume IX: What Makes a Successful Transition? University of Virginia White Burkett Miller Center (Lanham Md: University Press of America, 1993), pp. 3-24. 6 William F. Mullen, “Perceptions of Carter’s Legislative Successes and Failures: Views from the Hill and the Liaison Staff,” Presidential Studies Quarterly 12, no. 4 (1982): 527. 7 George Hager and Eric Pianin, Mirage (New York: Random House, 1997), pp. 212-13. 8 Robert G. Kaiser, “Academics Say It’s Elementary: Gore Wins,” August 31, 2000, p. A12. 9 R. S. Erickson, “The 2000 Presidential Election In Perspective,” Political Science Quarterly, 116: 38.

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winning the popular vote and Bush eventually triumphant in the Electoral College. Electoral battleground targeting may have been responsible for such a close race.10 The election results reflected the fact that the candidates essentially divided the nation. Most of the urban industrial county and city areas cast their votes for Gore but most of the rural counties cast their votes for Bush. Two Americas appeared with two competing visions on the role of government, values, morality and the importance of character and leadership. All of this, in part caused by two candidates who pledged to the American people that they would govern by bringing people together for compromise and conciliation. Nothing would be settled on Election Day. Much has been written about the post Election Day phase of the 2000 presidential election from hanging chads to county wide recounts. We know of the animosity generated between the two campaign camps as illustrated in their legal challenges. We also know about the Supreme Court case Bush v. Gore which ended Bush versus Gore. The bitter 5-4 ruling reflected the divisions within the nation. What is less well known is the continuing impact of this election upon public policy. When the dust had settled on December 13, 2000, Candidate Bush had become President George W. Bush. His congressional coattails were non-existent. His party lost three seats in the U.S. House of Representatives and four seats in the U. S. Senate. The Senate was now evenly split 50 to 50 and both parties had to agree to a power sharing arrangement.11 Within a mere one hundred and thirty –six days from the inauguration the United States Senate made history. Vermont Republican Senator James Jeffords announced that he was switching parties to become an independent. He would vote with the Democrats to effectively give them give control of the Senate. President Bush became the first president in U.S. history to lose party control of one house of Congress between national elections. By all accounts this was a weak presidency with no congressional coattails, a problematic and perhaps non existent mandate and more than half of the transition period lost to a contested presidential election. Presidential public opinion and job approval polls would hover, on average, around 55% until September 11th. It would be hard to cite another president facing such monumental problems of political capital so early in an administration. What type of transition could possibly be salvaged from such circumstances? On the surface it appeared that the transition was disciplined, organized and effective. There is evidence that the Bush II transition was underway in the spring of 1999 under the direction of a Bush II friend and former Yale classmate, Clay Johnson. Plans were undertaken to provide for a successful transition.12 Yet despite the early planning no one could predict the loss of time due to the contested election. On November 26 2000 Bush announced that Vice President designate Dick Cheney would run the transition operation. Cheney immediately attempted to secure a federal facility for transition purposes and to acquire federal funding for the operation. The General Services Administration gave the Bush team a setback when it refused to allow transition funding until there was a clear winner in the presidential contest. This implied that more time would be lost. It was not until November 29 that Cheney secured a private facility from which transition operations could be 10

Ibid. p. 43. Gary C. Jacobson, “A House and Senate Divided: The Clinton Legacy and the Congressional Elections of 2000,” Political Science Quarterly, 116: 5-28. 12 John P. Burke, “The Bush Transition,” in Gary L. Gregg II and Mark J. Rozell, Considering the Bush Presidency (New York: Oxford University Press), 2004 pp.22-25. 11

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conducted. 13 There was another problem. The transition organization employed advisory teams of up to 474 members. These people were to fan out and advise the various bureaucracies on transition appointments. Most of these people were heavy Bush II campaign contributors or people who worked on the transitions of Bush I or President Reagan. Many of these people were also lobbyists or corporate executives. A more select group of 85 transition advisers referred to as a “coordinating “group dealt directly with bureaucratic agencies. This group was comprised of GOP congressional staffers. At this time, Paul Light noted that the lateness of this transition could cause problems due to a nominee’s possible relationship with issues lobbied for by the transition people.14 Generally, President Bush was given a lot of credit for having his cabinet appointees in place early despite the problems surrounding the election. However, the administration was not so effective in filling the top federal posts. In fact the Brookings Institution concluded that, “On average, Bush appointees were confirmed 8.5 months after the inauguration compared to 2.3 months during J.F.K.’s administration.”15 Furthermore, there were many key federal vacancies left unfilled in the administration for up to twenty two months.16 This was well after September 11th. In this environment many Clinton appointees were asked to serve on including Richard A. Clarke at the National Security Council.17 This touched off a mini firestorm of controversy between the new Bush II administration and the conservative interest group community. The infighting at the sub cabinet level was intense and involved controversy over an appointees’ ideology.18 Those especially targeted were Clinton appointees and this controversy well exceeded the month of March in the new administration.19 In fact the phrase “complete and total disarray” was used to describe the first month in Secretary of Defense Rumsfeld’s office.20 Of course it did not appeal to conservatives that the early Bush Administration was reaching out and discussing cabinet posts with prominent democrats such as Senator John Breaux from Louisiana.21 There were various other things that affected the transition process. For example, there were reports of dirty tricks between the outgoing Clinton Administration and the incoming Bush Administration. There were reports of vandalism attributed to outgoing Clinton aides such as popping all the “W” keys off computer keyboards, the cutting of wires and the appropriating of official signs. All of this had occurred in past administrations and probably was a reflection of the bitter presidential contest but an administration facing a shortened transition did not find any humor in these situations.22 Another subtle indication that things were progressing slowly was a White House web site that was not up to speed as late as April 13

Ibid, p. 26. John Mintz, “Transition Advisers Have Much To Gain,” The Washington Post, January 17, 2001, p. A15. 15 Kathryn Dunn Tenpas and Stephen Hess, “Organizing the Bush Presidency,” in Gary l. Gregg II and Mark J. Rozell, eds. Considering the Bush Presidency (New York: Oxford University Press) 2004, P. 15. 16 Ibid. 17 Al Kamen, “In The Loop,” The Washington Post, January 19, 2001. 18 Steven Mufson, “Republicans At Odds Over Who Is Hired,” The Washington Post, January 31, 2001. 19 Ellen Nakashima, “Clinton Holdovers Targeted: Conservatives Fault Bush Transition Pace,” The Washington Post, March 23, 2001. 20 Bob Woodward, Plan of Attack (New York: Simon and Schuster), 2004, P. 14. 21 Mike Allen and Dana Milbank, “Bush Reaches Out To Democrats,” The Washington Post, December 15, 2000, p. A1. 22 Mike Allen, “New Administration Cataloguing Pranks,” The Washington Post January 26, 2001, P. A1, 10. 14

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of 2001.23 Finally, there were reports that the White House was having difficulty attracting staffers because they were paying significantly less than Congress.24 All of these problems had effects upon policy but many of these problems did not surface until well after September 11th and the congressional mid term elections. We will consider some of the general problems that can be attributed to newness, haste, hubris and naiveté before we concentrate upon the Iraq policy problem.

GENDERAL PROBLEMS STEMMING FROM THE TRANSITION One of the problems that all incoming presidents face after an inter party changing election is the relationship with the outgoing president. The 2000 presidential election caused bitter feelings between outgoing and incoming administration personnel as illustrated by the “dirty tricks” claim. There was a sense that the Bush II Administration was going to do thing differently than the Clinton Administration. Any Clinton policy advice was suspect. Thus newness and hubris helped to cancel out any benefit of advice derived from the Clinton people. This, would in turn impact policy and affect the tragedy of September 11th.25 Former president Clinton recalls giving incoming President Bush advice concerning terrorism and security issues with Osama bin Laden and al Qaeda at the top of the list. President Bush changed to subject from policy to the nature of the president’s job.26 Again newness, hubris and perhaps a little naiveté were at work here. One way of combating these traits is to think about formal, mandated and structured ties to both incoming and outgoing administrations. The Bush Administration also faced enormous political problems. The 2000 presidential election did not convey a mandate for the policies that the president campaigned for. There was public ambivalence toward the president’s tax cut policies. The president was also declining in the national polls as early summer and fall approached.27 The Administration decided to combat this built in insecurity stemming from the election by pursuing a policy of confrontation with Congress and expending political capital to pass a huge tax cut bill. This strategy, developed in the transition period, would hopefully demonstrate leadership.28 While it was successful in obtaining passage for the tax cut bill the price was the loss of control in the Senate with the Jeffords defection. This endangered the rest of the president’s agenda until September 11th intervened and it cast doubt on the White House staff’s ability to manage political problems. Again newness, hubris, haste and perhaps a little bit of arrogance were at work here. There were also other problems such as the Linda Chavez nomination for the Labor Secretary post which the administration had to rescind. It was blamed on an improper vetting 23

Ben White, “White House Web Site Blasted for too Much White Space,” The Washington Post, April 30 2001. Dana Milbank, “Bush White House So Far: Pinching Pennies and Lips,” The Washington Post, February 9, 2001 P. A27. 25 See Richard A. Clarke’s discussion of this in, Against All Enemies: Inside America’s War on Terror (New York: Free Press), 2004. pp. 225-26. 26 Bill Clinton, My Life (New York: Alfred A. Knopf), 2004, P. 935. 27 George C. Edwards III, “Riding High in the Polls,” in Colin Campbell and Bert A. Rockman, eds., The George Bush Presidency: Appraisals and Prospects (Washington D.C.: CQ Press), 2004, p. 21-23. 28 Colin Campbell, “Managing the Presidency or the President?” in Colin Campbell and Bert A. Rockman, eds., The George W. Bush Presidency: Appraisals and Prospects (Washington D.C.: CQ Press), 2004, pp. 5-6. 24

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process. There was also the problem concerning the Treasury Secretary Paul O’Neill’s financial dealings which received negative press.29 Again, perhaps a vetting problem. Eventually the Enron scandal would catch the Administration by surprise and then there was the matter of the President’s Faith Based Initiatives which went the way of Clinton’s proposed Gays in the Military initiative. 30 All of these problems in some part exhibit traits of newness, haste, hubris and naiveté. Before the tragedy of September 11th the Bush II Administration was facing perceptions of disorganization, contradictory policies and perhaps general incompetence. The shortened transition period was causing difficulties. Treasury Secretary Paul O’Neill observed these problems first hand. In describing the early internal battles within the Administration over Iraq he observed: ….George W. Bush was just learning the issues. Surround a president like that with one of the most experience-heavy teams of any recent administration, and you have senior officials both formulating and, in some cases, conducting U.S. policy. It was a broken process, O’Neill thought, or rather no process at all; there seemed to be no 31 apparatus to assess policy and deliberate effectively, to create coherent governance.

This observation occurred in the first month of the new administration. With the shortened transition there were pressures to at least get the senior cabinet level posts appointed. Haste was at work here. Most observers agreed that the cabinet secretaries were accomplished conservatives and quite a diverse group.32 However, it seemed that very little attention was paid to exactly how they fit together and how they would interact together. In fact, both the President and Vice President may have placed a premium on early nominations of respected people above all else. For example, main stream economic conservatives like Paul O’Neill were mixed in with hard line supply siders like Larry Lindsay and Glenn Hubbard. Amazingly O’Neill tried to warn both Vice President Cheney and President Bush about this when he read them a list of reasons why he should not be considered for the Treasury post. He told them of his work on global climate change, of his independent mind, of his call for a 50 cent per gallon increase in the cost of gasoline, of his avocation for the development of alternative energy sources, of his frankness. He was essentially telling them that he may not be ideologically compatible with them or their administration. They did not care. They wanted him anyway.33 They needed him and his public portfolio, his integrity, his reputation especially now after such an election, such a transition. How he would fit when making policy would come later. The same could be said of Secretary of State Colin Powell who was known as a cautious man especially when it came to war. The result was economic policy in large part based upon tax cuts that were not well thought out. In fact, O’Neill and Federal Reserve Chairman Greenspan entered into a pact to promote the congressional passage of economic triggers if the tax cut bill led to deficits. They lost by only one vote in the Senate 5- to 49. This was an extraordinary undertaking. The 29

For a discussion of this see Ron Suskind, The Price of Loyalty: George W. Bush, the White House and the education of Paul O’Neill (New York: Simon and Schuster), 2004, pp. 157-59. 30 For a discussion of the Faith Based Initiatives see, Ibid. p. 170. 31 Ibid. p. 97. 32 Dana Milbank, “3 Nominees Round Out Diverse Cabinet,” The Washington Post, January 3, 2001, p. A1. 33 Suskind, The Price of Loyalty, pp. 26-27.

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President’s own Treasury Secretary and the Federal Reserve Chair altering the President’s economic policy for the good of the nation. This was an extremely deep division early in the administration directly traceable to a high level appointment.34 The drama does not end there. O’Neill describes deep division in environmental policies. For example former New Jersey Governor Christie Todd Whitman as Environmental Protection Agency chief argued against withdrawing from the Kyoto Protocol and for stronger measures to combat global warming. 35 There were also divisions in health care policy especially concerning the now famous stem cell divisions.36 Perhaps to combat these divisions O’Neill describes the stacking of task forces and commissions such as Vice President’s Cheney’s Energy Task Force and the Social Security Commission with right wing conservatives.37 Thus while divisions persisted throughout these various policy areas the eventual adopted policies were foreordained. In addition to these problems the president, according to O’Neill, seemed disengaged from the details of policy. There was a lack of attention to detail or in acquisitiveness. It seemed as though the president was starting from scratch on most issues. Therefore he ceded authority to others. 38 Was it possible that the short transition and controversial election lead to a small circle of ideological advisers? Were appointments like Powell, O’Neill, Whitman, Minetta (at Transportation) a cover for ideological policy making in the economic, environmental, health care and foreign policy areas? Or was it more basic than that. Did newness, haste, hubris and naiveté contribute to such divisions and lengthen the president’s learning curve? Did it inhibit him from making competent decision making? In short was it ideology or incompetence or was it both? We will see some of the same divisions and problems in the foreign policy area especially concerning the Bush II Administration’s Iraqi policy.

THE BUSH TRANSITION AND FOREIGN POLICY In foreign policy the George W. Bush administration addressed two crises where the dynamics of the transition process influenced the decisions made: the emergency landing of an American surveillance aircraft in China after a mid air collision with a Chinese fighter and the terrorist attacks on the World Trade Center and the Pentagon. They present an interesting juxtaposition of cases. In the first crisis the president emerged as a “deal-maker” and not a “confrontation-seeker.”39 In the second crisis the imagery is reversed as his administration almost from the outset looked to expand the War on Terrorism to Iraq on questionable intelligence.40 34

Ibid. p. 40. Ibid. pp. 121-123. 36 For a discussion of this see, Anthony J. Eksterowicz and Nancy B. Eksterowicz, “ Pain Care and Stem Cells: The Effect of Political Ideology on the Patient Centered Paradigm of Health Care,” Paper delivered at the Annual Southern Political Science Association, New Orleans, January 7-10,2004. 37 Suskind, The Price of Loyalty, pp. 152-56. 38 Ibid .p. 126. 39 William Schneider, “Bush Wins ‘Lets Make A Deal,” The National Journal April 21, 2001, p. 1194. 40 Glenn Hastedt, “Public Intelligence,” International Journal of Intelligence and Counterintelligence, forthcoming. 35

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The first foreign policy crisis for the new administration began on March 31, 2001 and has now become all but forgotten after the tragic events of September 11, 2001. Not even 100 days into his presidency George W. Bush was forced to respond to an international incident in Asia. A U.S. naval surveillance plane collided with a Chinese fighter in international waters over the South China Sea. The U.S. plane and its crew of twenty-four landed safely in China. China blamed the incident on the United States and demanded a formal apology for the collision and the death of a Chinese pilot. The Bush administration refused to apologize (instead it expressed regret over the incident). It blamed the collision on China and demanded the release of the American crew and the damaged plane. The president warned that China’s refusal to act could harm U.S.-Chinese relations. The “failure of the Chinese government to react promptly to our request…is inconsistent with the expressed desire of both our countries for better relations.”41 Bush took no questions in demanding a “prompt” return of the plane and crew. The president was determined to keep a low profile public stance mindful of how the Carter presidency had become engulfed and tarred by the steady stream of attention focused on the White House by the Iranian hostage crisis of 1979. This, his first public statement on the issue, came on April 2. He also continued his schedule of public appearances. The administration further sought to reduce the scope of the crisis a few days later. On April 4 Secretary of State Colin Powell spoke of U.S. regret and sorrow over the death of the Chinese fighter pilot. On April 5, White House press secretary Ari Fleischer stated the 24 Americans held in China are not hostages. They were not even “detainees.” “The president refers to them as servicemen and women.” A navy spokesperson said the plane was not a spy plane but a surveillance aircraft.42 Relations stiffened on April 9 when the United States failed to send representatives to the Chinese Embassy when it hosted a reception for the new Chinese ambassador to the United States. The next day President Bush warned that “diplomacy takes time” but also warned that at some point “our relations with China become damaged.” At the same time the Pentagon moved to document that fault lay with the Chinese pilot for the collision.43 The situation soon improved, however, as compromise wording was found that would bring about the release of the American crew. On April 12, after Bush approved a communiqué to China in which the U.S. stated it was “very sorry” over the loss of the Chinese pilot’s life, China released the 24 American service people. It would be July 5 before the fuselage and other parts of the American plane would return to the United States. The decision-making dynamics of the crisis supports evidence of many of the traits that would come to be associated with the Bush Administration’s handling of foreign policy. First, Bush appears to have set the broad parameters of the policy (that it was a diplomatic problem) and then delegated to others the responsibility for follow through with the State Department taking the organization lead in the crisis. His personal involvement appears to have been highly selective determining that Secretary of Defense Donald Rumsfeld should not speak out on the issue for fear of inflaming the situation by inquiring if the pilots had bibles, were getting enough exercise and were staying in the equivalent of officer’s quarters. Second, Bush 41

David E. Sanger, “Bush is Demanding A Prompt Return of Plane and Crew,” The New York Times, April 3, 2001, p. 1. 42 Dana Milbank, “No Spies, No Incident, No Apology,” The Washington Post, April 5, 2001, C1. 43 Mike Allen and Steven Mufson, “Bush Backs Diplomacy,” The Washington Post, April 10, 2001, A1.

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demanded loyalty from those involved in the decision stressing “we don’t need to be pointing fingers.” Third, Bush created a crisis management group to coordinate U.S. policy. It was composed of Powell, Deputy Secretary of State Richard Armitage, “Scooter” Libby, Vice President Cheney’s chief of staff, national security advisors Condloeezza Rice, her deputy Stephen Hadley, and Deputy Secretary of Defense Paul Wolfowitz. Finally, Bush demonstrated his penchant for conceptualizing complex foreign policy problems in stark black and white language that appealed to his conservative political base in the U.S. but played out poorly abroad. In late April the United States announced an offer to sell a major arms package to Taiwan. This action had been contemplated during the crisis as a means of showing U.S. displeasure with Chinese intransigence in returning the 24 Americans. China was known to oppose the sale. The day after it was announced, Bush proclaimed the United States would do “whatever it took” to defend Taiwan. Questions immediately arose both in China and the United States as to whether the president was signaling a fundamental shift in U.S. policy toward China and Taiwan which has been deliberately ambiguous about how it would respond to such a clash. The administration quickly put out the word that no change in policy was contained in the president’s comments. Not unexpectedly George W. Bush’s initial inclination was to pursue a foreign policy that was “anything but Clinton”44 And, Bush had heavily criticized Clinton for his failure to pursue a more aggressive policy toward China. This impulse should have directed Bush to take a more unbending stance toward China in this crisis. This did not happen because this impulse was offset by the halting and incomplete nature of the foreign policy transition process, most notably the failure to put his “team” in place and translate this impulse into policy. Secretary of State Powell’s isolation in the administration is frequently noted. Ivo Daalder and James Lindsay note that he was on the defensive from the outset of the administration and that his pragmatic approach to foreign policy had no support in the national security bureaucracy that was staffed by allies of Vice President Dick Cheney and Secretary of Defense Rumsfeld.45 At this point, however, it is important to recognize that this isolation, especially within the State Department, was incomplete. It was not until May 11 that John Bolton was sworn in as Under Secretary of State for Arms Control and International Security. Bolton was forced upon Powell. Prior to coming into the administration he was an outspoken defender of Taiwan who wanted to see the United States recognize it as an independent state and opposed the one China policy. As a member of the Bush administration he would take a hard line stance against North Korea. Similarly, it was not until April 30 that Bush introduced Clark Randt as his choice for ambassador to China. It was Clinton’s ambassador, Joseph Prueher, who served as the Bush administration’s eyes and ears in China during the crisis. Prueher was cited as having played an important role in urging the Bush administration to ease tensions and seek a diplomatic solution.46 Also contributing to the nonconfrontational manner in which the crisis was resolved was the desire of hawkish members of the Bush administration to separate themselves from previous Republican administrations much as Clinton appointees sought to distance 44

Ivo Daalder and James Lindsay, America Unbound (Washington, D.C.: Brookings Institution, 2003), p. 37. Ibid., pp. 58-59. 46 Steven Mufson and Dana Milbank, “Diplomats Resurgent in Bush’s 1st Test,” The Washington Post, April 13, A1. 45

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themselves from Carter foreign policy experts. In this case it led them to endorse Powell’s efforts at a diplomatic solution in order to “prevent Bush from calling on people from his father’s and other GOP administrations whom the hard liners regard as too eager to accommodate China.”47 This failure to pursue a more aggressive policy toward China in the crisis did not go unnoticed. Frank Gaffney, a Pentagon official under Reagan, predicted during the crisis that Bush’s failure to take a tougher line with China would be the “end of the Bush honeymoon with conservatives who believed that China was a real threat. He observed “there is a growing restiveness among conservatives, who feel he is giving these guys a pass.”48 Viewed in combination with the timing of the above appointments, Bush’s unqualified pro-Taiwan statement that occurred at the end of the crisis and almost set of another crisis is consistent with proclivity of presidents to view foreign policy decisions largely in the context of domestic politics. It was an attempt to reconnect with his conservative political base. Generally speaking Bush received high marks for his nonconfrontational handling of the crisis. Yet to the surprise of many the China problem was not an accurate barometer of how he and his administration would handle the next foreign policy crisis to confront it. No one was surprised by the swift military response against al Qaeda and its Taliban benefactors in Afghanistan for the September 11 terrorist attacks. What was surprising was the quick embrace of Iraq as an enemy. The transition dynamics we have identified provide us with insight into why this was the case. The second major foreign policy decision of the Bush administration that clearly was affected by the transition was the War on Terrorism.49 Linkages between the two are evident in three areas. The first involves the nature of the collaboration between the outgoing Clinton administration and the incoming Bush administration. While the 9/11 Commission did not single out either the outgoing Clinton administration or the incoming George W. Bush administration for responsibility in failing to avert the tragedy of September 11 we can find signs of impending problems in the transition period. Most strikingly, the two sides have different memories about the urgency of the terrorist problem facing the country in 2000. During the presidential campaign and the transition George W. Bush and his key advisors all received intelligence briefings. One hour of an early September briefing was devoted to terrorism. After the election the CIA set up an office in Crawford, Texas to brief the president-elect. At one briefing in Washington Bush asked if the CIA could kill bin Laden. Director of Central Intelligence George Tenet replied this would not end the threat. Rice and Vice-President elect Dick Cheney were also at this two and one half hour meeting. They were told bin Laden was a “tremendous” and “immediate threat” and that his group was coming at the United States again. Along with weapons of mass destruction and China, bin Laden was presented as one of the three top challenges facing the U.S. Also in December Bush met with Clinton for a two hour one-on-one discussion of foreign policy. Recollections of the meeting differ. Clinton recalls saying one of his great regrets was not getting bin Laden. Bush is sure Clinton said something about terrorism but does not remember much being said about al Qaeda. In early January Dick Clarke who spearheaded 47

Ibid. Allen and Mufson, “Bush Backs Diplomacy.” 49 Material in this section is drawn from The 9/11 Commission Report (New York: Norton, 2004) and The 9/11 Investigations (New York: Public Affairs Reports, 2004). 48

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Clinton’s anti-terrorism effort and would be asked to stay on in the Bush administration briefed Rice, Cheney and his top aide, along with Secretary of State designate Colin Powell on terrorism. Clinton’s national security advisor Sandy Berger recalls stopping by at the meeting to stress the importance of the issue and telling Rice she would spend more time on terrorism in general and al Qaeda in particular than on any other issue. Rice remembers there being less of an emphasis on these issues in the discussion. A second area of linkage between the transition process and the War on Terrorism is found in the pace of decision making on terrorism in the new administration. It was not as high a priority for the incoming George W. Bush administration as was China, missile defense, the Persian Gulf, and the Middle East peace process. While the new administration retained Clinton’s key antiterrorism advisor, Richard Clarke, and his staff it altered its place in the national security decision making process downward. He reported to the Deputies Committee chaired by national Security advisor Condoleezza Rice’s top aide Stephen Hadley rather than directly to the Principles Committee made up of the key national security secretaries and chaired by Rice. Clarke objected to the move. Rice justified it as necessary to place the administration’s counterterrorism efforts in broader context. One of Rice’s first acts was to request her NSC staff to identify major policy reviews or initiatives. Clarke submitted a memo January 25, 2001 offering plans drawn up but not approved in December 2000 and 1998. Clarke also asked on several occasions for an early Principles Meeting where he could present information on al Qaeda. In one early request he stated such a meeting as “urgently’ needed. No Principles Meeting was held on the subject until September 4, 2001. Formal and informal meetings were held to discuss terrorism below this level. In March Hadley met with a group to discuss action against al Qaeda in Afghanistan and the drafting of a new presidential directive on terrorism. One point of dispute in the deliberations of the Deputies Committee chaired by Hadley which had jurisdiction on Afghanistan centered on the administration’s desire to have a policy in place on Afghanistan and Pakistan before dealing with al Qaeda and Clarke’s desire to move forward separately on these matters. He felt linking them had slowed down the decision making process too much. On April 30 the CIA briefed the Deputies Committee and described al Qaeda as “the most dangerous group we are facing.” One of the slides warned “there will be more attacks.” In May Rice reported that Director of Central Intelligence George Tenet briefed the president on the terrorist threat. Bush expressed impatience with “swatting flies” and wished to go on the offensive. This led Clarke and the NSC staff to put forward a broad policy initiative to eliminate al Qaeda. Hadley circulated it for comment as “an admittedly ambitious program.” Also in May Bush announced that Vice President Dick Cheney would lead a review of preparations for managing a possible weapons of mass destruction attack. The next few months were spent organizing the inquiry. In early August the CIA prepared an analysis of how terrorists might attack the U.S. for inclusion in the President’s Daily Brief of August 6. This was done in response to periodic questions by the president if any of this information pointed to an attack on the United States. Rice and Hadley also reviewed a draft presidential directive on al Qaeda. Rice felt it was “very good” and scheduled it to be discussed at the Principles Group meeting of September 4 before going forward to George W. Bush. Before that meeting took place Clarke wrote to Rice about his frustrations with the pace of decision making and urged policy makers to “imagine a day after a terrorist attack, with hundreds of Americans dead at home and abroad.”

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Rice chaired the September 4 meeting and according to the 9/11 Commission the draft presidential directive that called for expanded covert operations against al Qaeda was apparently approved. On September 10 Hadley’s committee met to finalize their recommendations for a three phase, multi year plan to bring down the Taliban leadership. Three factors appear to have influenced the slow pace of decision making. The first two are linked. Richard Posner asserts that by the time the Bush administration took office “bin Laden fatigue” had set in.50 He sees the Clinton administration has having tired of attempting to capture or kill Osama bin Laden in spite of the warnings it passed on to the Bush administration. Second, rather than taking up the challenge as Clarke sought the new administration was determined to pursue an “anything but Clinton” foreign policy. Since neither of these traits, the exhaustion of an outgoing administration nor the desire of the incoming administration to distance itself from its predecessor are unique to Clinton and Bush, the situation points to the need for an improved method for linking the outgoing and incoming foreign policy teams. Third, the slow pace of decision making is consistent with the overconfidence and self-centeredness of a new administration. Absent in all accounts of pre 9/11 Bush administration deliberations on terrorism is a sense of urgency. The unstated assumption was that the world would wait for the United States to select its strategy and then respond. No consideration was given to the possibility that the new administration might have to adopt a policy on the timetable of others. While it is not unique to the Bush administration this conviction is startling and shows the difficulty that new administrations have in learning given that it had already experienced one foreign policy crisis that caught it off guard. The third area of linkage between the War on Terrorism and the transition is the expansion of that war to include Iraq. Paul O’Neill is not alone in commenting on how quickly, and for many how unexpectedly, Iraq emerged as a prime target in the War on Terrorism after the 9/11 attacks.51 Transition dynamics shed light on how this was possible. New administrations tend to be drawn to campaign rhetoric and position papers in formulating their positions on issues rather than relying upon policy analysis carried out by their newly inherited foreign policy establishment. In the 2000 presidential election references to terrorism, much less Iraq, were few in number. Yet, one does not have to look too far in the past to find a clearly articulated strategy for linking Iraq and terrorism. Five years earlier, Richard Pearle, Douglas Feith, and David Wurmser produced a think piece for Israel’s Prime Minister Benjamin Netanyahu. One of its recommendations was the removal of Saddam Hussein from power as a necessary step in making the Middle East less hostile to Israel.52 In waging war against Saddam Hussein, they recommended that Israel invoke a policy of preemption, striking first in self defense. The planning document even contained recommended text for a media campaign, language that appeared in the Bush administration’s public statements after 9/11. In the Bush administration Pearle was head of the Defense Policy Review Board, Feith was Undersecretary of Defense for Policy, and Wursmer was Cheney’s top Middle East expert. Somewhat earlier Paul Wolfowitz presented two arguments that bear on this decision. James Mann labels them the Strength Hypothesis and the Follower Hypothesis. Wolfowitz, a 50

Richard Posner, “The 9/11 Report: A Dissent,” The York Times Book Review, August 29, 2004, p. 9. Ron Suskind, The Price of Loyalty (New York: Simon & Schuster, 2004), p. 188. 52 The study is entitled “Clean Break” and is discussed in James Bamford, A Pretext for War (New York: Doubleday, 2004). 51

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vocal opponent of Clinton’s foreign policy, argued in 1997 that the reason America’s allies were reluctant to follow Clinton’s policy against Iraq was because they perceived that the administration was weak. He continued that if the United States led with strength others would follow. “A willingness to act unilaterally can be the most effective way of securing collective action.”53 Here again is evidence of the pull of partisan pre-presidency thinking about foreign policy that becomes the basis for a new administration’s foreign policy due to the failure to make a transition from the politics of campaigning to the politics of governing.

CONCLUSION The two foreign policy crises illustrate lessons that can be applied to presidential transitions. During the China crisis the Bush Administration’s foreign policy team was not fully in place. Therefore there was significant collaboration and learning with and from the remnants of the Clinton foreign policy team. This helped to mitigate the problems of newness, haste, hubris and perhaps arrogance displayed by all new incoming presidential administrations. By the time the decision to invade Iraq came around the new Bush foreign policy team was fully in place and previous administration voices like Richard Clarke had been marginalized. Valuable information was not heard or ignored. Put another way, newness, haste and hubris had been institutionalized. How do we combat these trends and lay the foundation for smoother transitions? After all in our modern ear American national security is at stake. First, all incoming presidential administrations should understand that outgoing administrations have valuable information especially in the foreign policy realm. These administrations should be used as valuable resources. Second, having stated the obvious, the real problem is obtaining the cooperation of administrations that may be of different political parties. We can call for greater cooperation through such suggestions as incoming and outgoing staff to staff contact concerning domestic, international and national security issues, a reduction of political rhetoric between administrations and respect for a common mission for the nation but it is our judgment that these pleas will most likely fall on deaf ears. The ideological divide between the parties is probably too great to bridge without some formal help. That help comes in the form of legislation. The 9/11 Commission reviewed problems of transition. They noted the different styles between the Clinton and Bush Administrations.54 However, in their recommendations concerning presidential transitions they essentially focused on methods for improving the appointment process by speeding up the process. 55 One wonders how a quicker appointment process would have affected the China crisis? We believe that greater collaboration, education, and information exchanges are part of the answer between incoming and outgoing administrations especially those of differing political parties. How do we get them to work together? The Congress has a role here. It is our contention that diverse administrations will not naturally want to work together therefore they should be mandated by legislation to do so. 53 54

James Mann, “Bush Wanted His Doctrine And the Allies, Too,” The Washington Post, March 16, 2003, B1. The 9/11 Commission Report, pp. 198-203

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The Congress has done this in the past by funding presidential transitions. It can do so again. What specifically would be required? First, Congress should establish and mandate a process for greater staff to staff level contact between outgoing and incoming administrations in the vital international, domestic and national security areas. These contacts should be a matter of public record (with the usual precautions for national security matters) and the Congress should provide funding for these contacts. Some of this funding is already in place under the Presidential Transition Act. Second, the Congress should establish and fund a bipartisan presidential transition commission .This commission would conduct research into presidential transition problems, fund seminars for potential presidential transition advisers and generally serve as a resource base or library of information on the perils of presidential transitions. The commission would be active before, during and after presidential transitions. Such a commission could form educational alliances with existing university organizations and think tanks currently researching these issues. Previous participants in presidential transitions could also serve as valuable resources for such a commission. Presidential transitions can be difficult periods for our nation. We must begin the process of systematically examining these periods with the aim of strengthening them. Wishing and hoping that they will get better by merely providing suggestions is entirely inadequate. Any suggestion must be backed with the full force of funding and mandated legislation. Nothing less than our national security is at stake.

55

Ibid., 422-423.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 91-99

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

THE WHITE HOUSE BUDGET – WHAT IT ISN’T, WHAT IT IS: AND A FIVE-YEAR COMPARISON

Bradley H. Patterson ABSTRACT Presidents have an aversion to revealing the actual size and expense of the modern White House staff, and political scientists have not paid much attention to the question of how much it costs to operate that institution, including where the operating funds come from. This article sets forth the parts of the White House budget which are public, lays out the figures showing the changes in the past five years, and discusses the much larger portion of the White House finances which are partly or fully concealed. It further describes reform proposals President Bush is trying to make in his own backyard and illustrates congressional relationships related to White House appropriations.

INTRODUCTION What is, and how much is, the White House budget? At the outset, three clarifications are in order: (A) as used here, the term “White House” refers not to the building (the official name of which is “the Executive Residence”) but refers to the presidential staff; (B) the “White House,” the personal staff for the president is part of, but different from the institutional staff of the president which is called the Executive Office of the President; and, (C) even the body of people called “White House” has two meanings:

“White House” Defined Definition one: the White House staff community is a group of at least 133 separately identifiable units in which some six thousand men and women directly serve the presidency. Besides the well-known elements; such as the Chief of Staff, National Security Adviser, Senior Political Adviser, this staff community also includes the Office of the Vice President, the very large White House Military Office, the presidential and vice-presidential protective units of the U.S. Secret Service, teams from the National Park Service, from the General Services Administration, and from the U. S. Post Service, dozens of detailees from other

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federal agencies, plus the White House interns, White House Fellows and the many White House volunteers.1 Definition two: the elements publicly labeled as “White House” in the president’s annual budget presentation made to the Congress include a narrower portion of the 133, i.e. only: ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ

Compensation of the President The White House Office The Executive Residence (Operating outlays plus funds for Repair and Restoration The Office of Policy Development (which includes the Domestic and Economic Councils and the National AIDS Policy Coordinator) The National Security Council (i.e. the staff of the NSC) The Office of Homeland Security (i.e. the staff of the new Homeland Security Council) Unanticipated Needs of the President The Office of Administration (in its entirety) The Council of Economic Advisers

In the author’s judgment, the Council of Economic Advisers, an institution established by statute in 1946, is not part of the White House, and more properly should be categorized as an element of the Executive Office of the President. Likewise, only about one-half of the personnel in the Office of Administration directly serve the president; the other half should be considered as part of the Executive Office. The author also maintains that, today, the Office of the Vice President is so closely joined into the White House community that its outlays, for staff costs and for residence expenses, should be counted in the White House total. The other major elements which make up the Executive Office of the President, i.e., the Office of Management and Budget (OMB), the Office of National Drug Control Policy (ONDCP), the Office of the U.S. Trade Representative (USTR), the Office Science and Technology Policy (OSTP), and the Council on Environmental Policy (CEQ), are institutional rather than personal presidential staff, and are not included in either of the two definitions of “White House.”

THE WHITE HOUSE BUDGET THAT ISN’T The expenses of the White House in definition one are quite complex, and are largely concealed from the public. The White House Military Office is financed by the Department of Defense; the costs of its eleven sub-elements (e.g. the White House Communications Agency, Air Force One, Camp David) are embedded in a plethora of Department of Defense accounts, some of them classified. The outlays for the presidential/vice presidential protective operations of the U.S. Secret Service (itself now part of the Department of Homeland Security) are kept confidential for 1

Each of these White House elements is described in the author’s book The White House Staff: Inside the West Wing and Beyond (Washington, D.C., Brookings Institution Press, paperback edition, 2001.

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security reasons. The contributions of the National Park Service, General Services Administration, Postal Service, and of several other departments such as State, and the National Archives, are found only within the accounts of those respective agencies. The salaries of the many detailees serving at the White House are buried in the budgets of the multitude of agencies from which those detailees originate. An example of this multi-compartmented puzzle is the cost of presidential travel. President Clinton, for instance, made trips to Africa, Chile and China in 1998. Three senators asked the General Accounting Office to add up the expenses. For the African trip alone, the GAO reported, fourteen federal agencies supplied support for the president, thirteen of them contributing services costing $42,805,992;. the fourteenth agency, the Secret Service, citing national security concerns, refused, even to the General Accounting Office, to reveal its support costs – which were undoubtedly quite large.2 In his 2001 book, The White House Staff: Inside the West Wing and Beyond, the author assayed an estimate of all of these concealed or semi-concealed outlays for the whole White House staff community. His addition, for FY 2001, totaled $730,500,000. It is almost certainly much more today. Readers may share the author’s surprise to discover that no office in Washington even attempts to identify and assemble all of these White House expenditures to put together, analyze and evaluate a budget for the whole White House, broadly defined. This is not done in the White House itself, not in the Office of Administration, not in the Office of Management and Budget, and not anywhere in the Congress or by its General Accounting Office.

THE WHITE HOUSE BUDGET THAT IS This article focuses on the budget for the White House elements in definition two; that. within the White House, the budget process for its internal units is initially managed by the Assistant to the President for Management and Administration ; an office which had its beginnings under President Carter. This officer balances the always insistent requests from senior White House colleagues that expansion of their staffs is indispensable, with the equally insistent hope by every president that his staff will appear to be modest in size and parsimonious in expenditures. As a campaigner, Mr. Clinton, unwisely, promised to cut his staff by 25 percent. The Chief of Staff, and the President, finally weigh in; the resulting figures for the White House are put into the budget format by the staff of the Office of Administration. The requests for appropriations are then published in the comprehensive appendix to the president’s annual budget, and are also described in detail in a separate document entitled Congressional Budget Submission (for FY 2005 it is 269 pages) which covers not only the White House units, but also all the institutions in the Executive Office of the President.

2

U.S. General Accounting Office: Costs and Accounting For the President’s 1998 Trips to Africa, Chile and China, Report Number GAO/NSIAD-99-164, September, 1999.

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Bradley H. Patterson Table. The Budget Of The White House (As appropriated; for FY 2005, as requested)

President White House Office Executive Residence Vice President Office of Policy Development National Security Council ½ of the Office of Administration Unanticipated Needs Subtotal White House Office of Homeland Security Total (Patterson definition of “White House”) Council of Economic Advisers Other ½ of the Office of Administration Vice President Alternate Total (“White House” as defined in the Budget Presentation

FY 2001

FY2002

FY 2003

FY 2004

FY 2005

390,000 53,288,000 10,900,000 986,000 3,673,000 354,000 4,032,000

450,000 54,611,000 11,686,000 8,618,000 3,922,000 318,000 3,514,000

450,000 50,385,000 12,149,000 1,192,000 4,040,000 322,000 3,230,000

450,000 69,168,000 12,501,000 4,225,000 4,461,000 331,000 4,109,000

450,000 63,698,0003 12,760,000 1,900,000 4,571,000 333,000 3,592,000

7,165,000

7,488,000

7,770,000

10,551,000

8,932,000

21,868,500

46,955,9004

45,455,000

41,413,0005

42,838,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

103,638,500 0

138,562,000 26,955,1006

125,993,000 19,398,000

148,209,000 (7,231,000)

140,074,000 (7,300,000)7

103,638,500

165,518,000

145,391,000

148,209,000

140,074,000

+ 4,110,000

+ 4,208,000

+ 3,739,000

+ 4,502,000

+ 4,904,000

+ 21,868,000

+ 46,955,900

+ 45,455,000

+ 41,413,000

+ 42,838,000

- 4,027,000 125,589,000

- 4,243,000 212,438,900

- 4,390,000 190,195,000

- 4,792,000 189,332,0008

- 4,904,000 182,048,0009

The table above identifies the nine elements which, in the author’s judgment, constitute, in reality, the contemporary White House staff. These do include the Office of the Vice President but only half of the Office of Administration. In a complementary section, the table 3

This figure represents an increase, from FY 2004, for the White House Office, of $1,394,000 in personnel Costs and $1,744,000 in other expenses, but these increases are offset by some $8,411,000 in rental costs (for those White House Office units which are located in the Eisenhower Executive Office Building) and by other related charges which have been moved out of the White House Office budget into the Office of Administration accounts. 4 Of which $23,044,900 came in an FY 2002 Homeland Security supplemental. 5 Some $8,209,000 of OA’s total FY 2004 budget has subsequently been transferred out to the Office of Management and Budget accounts. The FY 2005 OA request includes $11,337,000 in incoming transfers, including the $8,411,000 referred to in endnote “a.” 6 Estimated; included in the OA budget as part of the FY 2002 Homeland Security supplemental. 7 The FY 2005 figure is an estimate by the author; the White House no longer publishes it. Both the FY 2004 and 2005 White House Homeland Security outlays are included in the respective White House Office accounts. 8 This total differs from the official figure of $179,615,000 due in part to the $11.3 million in transfers mentioned in endnote “c.” 9 The apparent reduction from the FY 2004 total is achieved by the $8,209,000 transfer to OMB .

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goes on to add in the Council of Economic Advisers, and the other half of the Office of Administration, and subtracts the vice presidential amount, yielding as a result the total which is used in the administration’s official budget presentation under the label “The White House.” The table displays the funds actually appropriated for the final budget of the Clinton White House (FY 2001), and for the first three years of President George W. Bush’s administration (FYs 2002-3-4). The last column represents President Bush’s FY 2005 request.

ANALYSIS AND OBSERVATIONS Even after transferring $8.2 million out of the White House accounts to the OMB appropriation, the publicly presented White House budget has increased by 44.9 percent over the last five years. A major increase occurred between FY 2000 and FY 2001 reflecting the emergency supplemental appropriation for homeland security; an enterprise which at that time took the form of a new, large element in the White House Office, created by Executive Order 13228 of October 8, 2001, and headed by former Governor Tom Ridge. By FY 2004, $16.8 million, and much of the personnel of that office had been switched to the new Department of Homeland Security, but a 66-person unit, including the staff of the Homeland Security Council, still stays within the White House. Reviewing the president’s FY 2004 request for that staff group, the House Appropriations Subcommittee opined that it was not clear what work remains that cannot be effectively performed by the Department of Homeland Security. Although the Committee understands the President’s need for policy support and advice, it is not clear why that would require 66 staff, given the existence and 10 support of the Department of Homeland Security.

The Committee recommended reducing the White House Homeland Security Office budget to $4,120,000, but in the final FY appropriations bill (HR 2673) this allocation was restored to $7,231,000. At it’s April 1, 2004 hearing on the FY 2005 request, the House Appropriations Subcommittee Chairman again raised the question of whether the White House itself needed such a large Office of Homeland Security in view of the creation of the amalgamation known as the Department of Homeland Security, and also in view of the coordinating responsibilities vested in the National Security Council. In response, the administration’s principal witness explained that there are agencies outside the national security community, e.g. Agriculture, Interior, which perform functions vital for homeland security. Effective interagency coordination must reach out to include them as well. Comparing the final year of the Clinton administration (FY 2001) with the upcoming year under President George W. Bush (FY 2005), we see that the “White House Office” budget rises by 19.5 percent, the vice president’s office by 21.8 percent, the National Security Council by 10.7 percent, and the White House-related half of the Office of Administration by 96 percent. 10

U.S. House of Representatives, One Hundred Eighth Congress, First Session, Committee on Appropriations, Report Number 108-243 re the Departments of Transportation and Treasury and Independent Agencies Appropriations Bill, 2004, July 30, 2003, 163

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In the author’s judgment, these increases are neither surprising nor unjustified. They reflect the increasingly centralized responsibilities and activities of the contemporary president and vice president, especially in a time of serious and unique national security threat.

THE PRESIDENT’S PROPOSED BUDGET REFORMS Beginning with his FY 2003 budget published in January, 2002, President Bush requested Congress give him more flexibility in managing the budgets both of his personal (White House) and of his institutional (Executive Office) units.11 First, he asked for authority to consolidate common functions within his own White House elements. Procurement and management of information technology, rent, printing and reproduction, supplies, materials and equipment had heretofore been separately conducted by each element; standardization suffered; costs were unnecessarily high. It was thought that consolidation would permit economies of scale. The appropriations subcommittees agreed, and earmarked some $13 million (plus another $8 million from OMB) for a pilot program of consolidation, to be run by the Office of Administration. This initiative was endorsed by the House Appropriations Subcommittee in its report on the FY 2004 appropriations legislation. As the FY 2005 request was being compiled, it turned out that the greatest economies in costs, and in administrative effectiveness were to be found in consolidating the handling of rents and of telecommunications expenses. In FY 2005, what is now called the “Core Enterprise Pilot Program” will focus on these two areas, and funds will be transferred from White House and Executive Office accounts to the Office of Administration to effect the consolidation. Second, President Bush asked Congress in his FY 2003 budget for a loosening of the strictures which deprive him of financial flexibility in his own budgetary backyard. He wanted to be able to “respond rapidly to fluid situations” and to “address emerging priorities and shifting demands.”12 At present, he cannot reprogram outlays within any one of those White House accounts by more than ten percent without giving 15 days advance notice to, and getting the imprimatur of, the House and Senate appropriations subcommittees; and he cannot transfer monies among those accounts without asking Congress to pass separate legislation in each instance. President Bush requested that he be given a blanket ten percent transfer authority among seven of the Executive Office appropriations: the White House Office, OMB, USTR, ONDCP, CEQ, OSTP and the Vice President’s Office too (with the approval of the vice president.) The appropriations committees would simply be given advance notice. Third, the president recommended that several of the White House accounts “that directly support the president’s executive role” actually be merged. His request was to lump together the planned outlays for the Compensation of the President, the White House Office (including the Homeland Security monies), the Executive Residence (including its Repair and Restoration funds), the Office of Policy Development, the Council of Economic Advisers, the 11 12

U.S. Office of Management and Budget, Budget Appendix, The Budget for Fiscal Year 2003, 882 Executive Office of the President, Fiscal Year 2005 Congressional Budget Submission, March 2004, 3.

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National Security Council and the Office of Administration into a single appropriation which would be labeled “The White House.” The President said in his FY 2004 budget: “This initiative provides enhanced flexibility in allocating resources and staff in support of the President and Vice President, and permits more rapid response to changing needs and priorities.”13

CONGRESSIONAL ACTION ON THE WHITE HOUSE BUDGET The initial and principal responsibility in the Congress for analyzing the budget submissions of the White House lies in the appropriations subcommittees; in the House the Subcommittee on Transportation, Treasury and Independent Agencies (chaired by Congressman Istook of Oklahoma with Congressman John Olver of Massachusetts as the ranking minority member), and in the Senate the Subcommittee on Transportation, Treasury and General Government (chaired by Senator Shelby of Alabama with Senator Murray of Washington the ranking minority member). Since the House of Representatives originates appropriations legislation, the House subcommittee acts first. A hearing is held, usually in the early spring, and it is the Director of the Office of Administration who is the principal witness. Members of the subcommittees have been known to fuss about the absence, at the witness table, of any of those very White House officers whose expenditures are being reviewed, but President Bush hews to the traditional rule that White House staffers do not (except in the rare instances of alleged criminality or scandal or, as in the recent case of Condoleeza Rice, of overwhelming political pressure, formally testify before congressional committees. On one occasion in 1997, the House Subcommittee was criticizing the division of the entertainment expenses of the White House between “official” and “political.” Finally the Assistant to the President for Management and Administration brought the White House Chief Usher (who manages the Residence) up to the Hill, and had him explain informally to subcommittee members that “the eggs in this soufflé were billed to the State Department because it was for an international dinner, but the eggs in this souffle…” There is a certain comity which is generally observed between the Congress and the president about the budgets of their respective institutions. OMB does not review, and the president does not comment on the budget of the legislative branch. For their part, the congressional appropriations subcommittees’ hearings on the White House budget submission are businesslike; the amounts requested are often approved without change. A few questions are directed at the OA witnesses, and follow-up answers are prepared; the hearings transcripts are later published. The House Subcommittee held its hearing for the FY 2005 White House budget request on April 1, 2004. Only three of the 15 subcommittee members attended, however, and the audience in the hearing room totaled 5. In some years (including the spring of 2004), the Senate subcommittee does not even hold hearings on the Executive Office request. The subject of the White House budget is not of intense congressional, or public interest.

13

U.S. Office of Management and Budget, Budget Appendix, The Budget for Fiscal Year 2004, 928.

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There are occasions when Congress does exercise its authority to give direction to, and set limits on White House financial operations. Two examples can be cited: the White House Communications Agency (WHCA, the largest element in the Defense-funded White House Military Office) handles the president’s encrypted telecommunications requirements. In 1996, the Inspector General of the Department of Defense reported to the House Committee on Government Reform and Oversight that the White House Office had been calling upon WHCA to provide support beyond WHCA’s official communications duties; i.e., making audio-visual recordings for the National Archives of all presidential events, providing stenographic services plus lecterns, flags, seals and teleprompters for all White House functions, camera equipment for the White House photographers, and providing newswire services to White House staffers. This was considered as inappropriately burdening WHCA’s resources.14 The following year, the House Appropriations Subcommittee saw to it that the FY 1998 appropriations legislation contained a requirement that White House Office funds be earmarked to reimburse WHCA for these “non-telecommunications” services. This statutory obligation has been repeated in the subsequent years. The FY 2004 appropriations act set the earmark at $8,650,000. The FY 2005 request increases that level of reimbursement to WHCA by $2,393,000 but also designates $543,000 of the total to be paid to the Department of State for providing “audiovisual support associated with Presidential Diplomatic Missions.” And, in 1998, the appropriations committees became annoyed at the lateness of payments of reimbursements due the White House from political or other recognized groups which are invited to sponsor events in the Executive Residence. A requirement was written into the appropriations act, and remains there today, that each such group shall pay for the estimated cost of its event in advance, and must within 60 days, be notified about any costs beyond the estimate, must pay these charges within 30 days of the notification, and must be charged interest and penalties if the reimbursement has not been made within that deadline. The president’s political party, furthermore, must maintain a separate deposit of $25,000 to cover costs of events it sponsors in the Residence.15 On occasion there is sheer harassment. In February of 1992, the House Post Office and Civil Service Committee; led by Congressman Paul Kanjorski, undertook an election-year vendetta against the Bush White House. Question after question was flung at the weary testifiers; (here is a sample:“How many floral arrangements, invitations, banners, streamers, balloons and other decorative items were used for each event at the White House or at the residence of the Vice President during 1991?”) Thousands of pages were generated in response.16

14

U.S. House of Representatives, One Hundred Fourth Congress, Second Session, Oversight of the White House Communications Agency (Hearings before the Subcommittee on National Security, International Affairs and Criminal Justice of the House Committee on Government Reform and Oversight), May 16 and June 13, 1996, 82. 15 U.S. Office of Management and Budget, Budget Appendix, The Budget for Fiscal Year 2003, 928. 16 As quoted in Patterson, The White House Staff: Inside the West Wing and Beyond, The Brookings Institution Press, Washington, D.C., 2001, p. 464, footnote 34.

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CONCLUSION The White House budget is an elusive concoction; partly well-displayed, and partly hidden, and exciting neither broad congressional nor public attention. The well-displayed segments are labeled “White House,” and are discussed in this article. As for those kept confidential, the author would contest the assertion that revealing the gross sum of the Secret Service’s protective costs would damage national security. If this figure were available; and if then, all of the expenses of the White House were assembled and added together, including those borne by the Department of Defense, it is the author’s belief that the current annual total would be over $1 billion. Presidents have their political reasons for being nervous about disclosing the whole White House budget picture, and about admitting that the modern White House staff community is in fact a large, complicated, and expensive institution. Less justifiable is the rarity with which presidential scholars themselves give attention to the total staff, and to its costs. Throwing more light on this picture would, the author believes, reveal not unconscionableness, but a reasonable, and bearable attentiveness to meeting the leadership needs of the nation.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 101-119

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

ARE ALL PRESIDENTIAL LEGISLATIVE SUCCESSES REALLY VICTORIES? EXAMINING THE SUBSTANCE OF LEGISLATION Andrew W. Barrett ABSTRACT Despite numerous studies focused on presidential success in the legislative arena, political scientists have largely ignored the president’s ability to shape the substance of legislation. This article examines 233 significant bills to measure presidential success in terms of legislative content over a twenty-year period and demonstrates that the president usually receives most of what he wants in terms of the substance of legislation when he signs a bill into law, but he usually accepts significant legislative concessions, including regarding his own initiatives and especially under divided government. These findings support Richard Neustadt’s argument that presidents must bargain to influence the lawmaking process. The results presented also suggest that congressional leaders must accommodate presidential wishes to secure passage of their own proposals.

INTRODUCTION Two major pieces of legislation proposed by President Jimmy Carter became law in October 1978; a civil service reform bill and a comprehensive energy package. Although Congress passed both of these presidential initiatives, Carter received much more of what he wanted in terms of legislative content regarding the former compared to the latter bill. The bill enacted to reform the civil service system “contained all but one of the basic changes the president had proposed” even though it was “reworked extensively by both the House and the Senate.”1 On the other hand, the final version of the energy package “contained only remnants of the tough plan originally presented by Carter.”2 Under most measures of presidential success in Congress previously used by political scientists (such as presidential box scores or success rates), Carter would have been credited with two equal legislative successes regarding these proposals since in each case a bill he initiated became law. Yet, as these two cases demonstrate, the passage of every presidential 1

“Congress Approves Civil Service Reform,” Congressional Quarterly Almanac, 1978 34 (1979), p. 818. “Energy Bill: The End of an Odyssey,” Congressional Quarterly Almanac, 1978 34 (1979), p. 639.

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proposal is not necessarily an equivalent legislative victory. In fact, if Congress dramatically alters or waters down a presidential proposal before it can be signed into law, has the president even won the legislative battle? A seemingly endless parade of political scientists have attempted to measure presidential success in the legislative arena over the past few decades. Regrettably, most of these scholars have ignored the most important aspect of the legislative battles that transpire between the president and Congress, the specific legislation in question. The focus has been on tallying presidential wins and losses, not on the final product produced by the lawmaking process. This past focus has created a gap in the literature on presidential legislative success since the president may win a legislative battle by prevailing on a single roll call vote or by signing a bill into law, but lose the legislative war if the proposal he signs has been gutted by Congress. This article begins to fill this gap by examining the content of 233 significant pieces of legislation over a twenty-year period to determine whether all presidential legislative successes are really victories. Based on the analyses conducted, the president usually receives most of what he wants in terms of the substance of legislation when he signs a bill into law, but he usually accepts significant legislative concessions, including his own proposals, and especially under divided government. It is also found that congressional leaders accommodate presidential wishes to secure passage of their own initiatives.

LITERATURE REVIEW Presidential scholars have studied presidential success in the legislative arena for many years. The methods most often adopted by these researchers include presidential box scores (in particular, those produced by Congressional Quarterly), success rates on roll call votes3 and/or support scores4 regarding a particular subset of votes and/or bills. Each of these measures -- although useful -- suffers from a number of different problems that limit their value, however.5 One shortcoming common to all of these measures is that they each ignore the content of the legislation being considered by Congress. These measures emphasize how often the president wins on a series of bills or how many votes he receives on a particular vote, yet they neglect whether the substance of the legislation that the lawmaking process produces is what the president wanted.

3

Dennis W. Gleiber and Steven A. Shull, “Presidential Influence in the Policymaking Process,” Western Political Quarterly 45 (1992), pp. 441-467; Brad Lockerbie, Stephen Borrelli, and Scott Hedger, “An Integrative Approach to Modeling Presidential Success in Congress,” Political Research Quarterly 51 (1998), pp. 155-172. 4 George C. Edwards III, At the Margins: Presidential Leadership of Congress (New Haven, CT: Yale University Press, 1989); Jon R. Bond and Richard Fleisher, The President in the Legislative Arena (Chicago: University of Chicago Press, 1990); Jon R. Bond and Richard Fleisher, “The President in a More Partisan Legislative Arena,” Political Research Quarterly 49 (1996), pp. 729-748. 5 Cary R. Covington, “Congressional Support for the President: The View from the Kennedy/Johnson White House,” Journal of Politics 48 (1986), pp. 717-728; James M. Lindsay and Wayne P. Steger, “The ‘Two Presidencies’ in Future Research: Moving Beyond Roll-Call Analysis,” Congress & the Presidency 20 (1993), pp. 103-117; Charles O. Jones, The Presidency in a Separated System (Washington, DC: Brookings Institution, 1994); Jon R. Bond, Richard Fleisher, and Glen S. Krutz, “An Overview of the Empirical Findings on Presidential-Congressional Relations,” in James A. Thurber, ed., Rivals for Power: Presidential-Congressional Relations (Washington, DC: Congressional Quarterly Press, 1996).

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In all likelihood, the primary reason scholars have ignored the content of legislation is the difficulty of measuring it quantitatively. Most pieces of legislation produced by Congress today are incredibly long, detailed and complicated. As a consequence, it is a problematic and time-consuming task to measure what the president wanted in regards to a legislative proposal and what Congress placed on his desk to sign (especially when one is examining hundreds of pieces of legislation). Despite the complexity of this task, an analysis of the substance of legislation is necessary if scholars want to more accurately measure presidential success in the legislative arena. The substance of legislation has not been completely ignored by political scientists. In his examining 299 presidential legislative initiatives from 1953-1984, Mark Peterson distinguishes between initiatives regarding which the president dominated the legislative process, and proposals on which the president needed to compromise.6 Likewise, Charles Jones touches on the president’s ability to shape the content of legislation, yet his main interest is “in identifying presidential and congressional participation at different points in the lawmaking process.”7 Scholars who are interested in the president's use of his veto power, and veto threats also have addressed the question of whether the president can alter the content of legislation.8 Finally, a few political scientists have briefly discussed the importance of examining the substance of legislation, yet taken no action. For example, in his study of divided government, David Mayhew talks about the quality and coherence of laws produced by Congress, but he does not analyze the substance of the bills he discusses.9 Despite these various studies, presidential success in Congress in terms of the substance of legislation has not been a popular research topic.

HYPOTHESES The formal powers of the president under the U.S. Constitution, as many scholars have asserted, are relatively weak, particularly in the legislative arena. Therefore, the president, according to Richard Neustadt, needs to use informal powers to persuade or bargain with other political actors to influence the policymaking process.10 Depending on persuasion may appear to be a precarious base of power; yet, the White House “controls the most encompassing array of vantage points in the American political system,” including the president’s status and authority, his professional reputation, and his public prestige.11 These vantage points enhance the president’s ability to persuade. 6

Mark Peterson, Legislating Together: The White House and Capitol Hill from Eisenhower to Reagan (Cambridge, MA: Harvard University Press, 1990). 7 Jones, The Presidency in a Separated System, p. 208. 8 See, for example, D. Roderick Kiewiet and Mathew D. McCubbins, “Presidential Influence on Congressional Appropriations Decisions,” American Journal of Political Science 32 (1988), pp. 713-736; Charles M. Cameron, Veto Bargaining: Presidents and the Politics of Negative Power (Cambridge, UK: Cambridge University Press, 2000). 9 David R. Mayhew, Divided We Govern: Party Control, Lawmaking, and Investigations,1946-1990 (New Haven, CT: Yale University Press, 1991). 10 Richard E. Neustadt, Presidential Power and the Modern Presidents: The Politics of Leadership from Roosevelt to Reagan (New York: The Free Press, 1990). 11 Ibid., p. 31.

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One aspect of presidential persuasion that scholars have largely ignored in their quantitative examinations of presidential legislative success involves bargaining in terms of the substance of legislation. To build a winning congressional coalition, presidents can offer to reshape their proposals more to the liking of important actors in the legislative process, such as a committee chairman or party leader. In other words, the president can create legislative support by making legislative compromises. Since the lawmaking process is long with many different obstacles to be overcome, it is likely the president will need to accept some level of legislative compromise to ensure the passage of his proposals. Thus, I hypothesize that presidents will accept a significant number of legislative concessions before they sign most bills into law. As a number of political scientists have demonstrated, the president’s ability to influence the lawmaking process is largely determined by the legislative environment that surrounds him.12 It is then reasonable to assume that presidents will have to bargain less in terms of legislative content when faced by a favorable legislative environment as opposed to a hostile one. The most important aspect of the legislative environment surrounding a president is whether his party controls one or both chambers of Congress.13 This leads to my second hypothesis that the president will be more successful in terms of the substance of legislation under unified compared to divided government. Another factor that may influence the president’s ability to shape the content of legislation is whether the proposal being considered in Congress is a presidential or congressional initiative. As Neustadt points out, the formal powers of the president and Congress “are so intertwined that neither will accomplish very much, for very long, without the acquiescence of the other. By the same token, though, what one demands the other can resist. The stage is set for that great game, much like collective bargaining, in which each seeks to profit from the other’s needs and fears.”14 When a bill is proposed by the White House, the president will likely need to accommodate congressional leaders by accepting legislative concessions to ensure its passage. Conversely, when a congressional initiative is being considered, the president’s bargaining advantage should be enhanced since he has the ability to kill a proposal with his veto pen that congressional leaders want to become law. Therefore, I also hypothesize that the initiator of a bill -- either the president or Congress -will need to accommodate the wishes of the other legislative actor in terms of the content of legislation to ensure that proposal becomes law.

12

Edwards, At the Margins; Bond and Fleisher, The President in the Legislative Arena; Peterson, Legislating Together; Jones, The Presidency in a Separated System. 13 See George C. Edwards III, Andrew Barrett, and Jeffrey Peake, “The Legislative Impact of Divided Government,” American Journal of Political Science 41 (1997), pp. 545-563. Some political scientists have argued that divided government does not hinder the legislative process, including Mayhew, Divided We Govern; Jones, The Presidency in a Separated System; and Charles O. Jones, Separate But Equal Branches: Congress and the Presidency (Chatham, N.J.: Chatham House, 1995). However, numerous scholars have shown that divided government does have important policymaking consequences, such as Gary W. Cox and Mathew D. McCubbins, “Divided Control of Fiscal Policy,” in Gary W. Cox and Samuel Kernell, eds., The Politics of Divided Government (Boulder, CO: Westview Press, 1991); Samuel Kernell, “Facing an Opposition Congress: The President’s Strategic Circumstance,” in Gary W. Cox and Samuel Kernell, eds., The Politics of Divided Government (Boulder, CO: Westview Press, 1991); James L. Sundquist, Constitutional Reform and Effective Government, rev. ed. (Washington, DC: Brookings Institution, 1992); Sean Q. Kelly, “Divided We Govern? A Reassessment,” Polity 25 (1993), pp. 475-484; and Edwards, Barrett, and Peake, “The Legislative Impact of Divided Government.” 14 Neustadt, Presidential Power and the Modern Presidents, p. 32.

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DATA AND METHODS To measure presidential success in terms of the substance of legislation, I developed a sample of bills by combining David Mayhew's list of important legislation that passed,15 and a list of potentially significant legislation that failed produced by George Edwards, Andrew Barrett, and Jeff Peake.16 The standard used both by Mayhew as well as Edwards and his colleagues to determine whether a bill was important or potentially significant was whether it was "both innovative and consequential.”17 Creating a sample of legislation from these two lists provides a number of advantages. First, these lists include both presidential and congressional initiatives, a necessity since one of the emphases of this study is the initiator of legislation. Second, as Jean Reith Schroedel demonstrates in her examination of banking legislation, presidents are more attentive to important policy initiatives, meaning that presidential involvement in the lawmaking process is more likely regarding significant pieces of legislation.18 Finally, the intensity of legislative battles should increase when significant legislation is debated because so much is at stake both politically and in terms of policymaking regarding these bills, providing for a good test of presidential success regarding the substance of legislation. To make this project manageable, it was limited to a twenty-year time period (19771996) encompassing four separate presidential administrations (Carter, Reagan, Bush, and Clinton).19 When combined for this period, the two aforementioned lists created a sample of 357 significant bills to analyze.20 However, I placed some limitations on this sample of bills. First, since the purpose of this study is to measure the president’s success at altering the content of legislation, I eliminated all bills from the Mayhew and Edwards, et al. lists whose substance the president had no interest in shaping, i.e., bills the president wanted killed or never took a public position on. In particular, I removed all bills that the president was inexorably opposed to, and simply wanted defeated, (and would not sign in any form), as well

15

Mayhew, Divided We Govern. Edwards, Barrett, and Peake, “The Legislative Impact of Divided Government.” 17 Mayhew, Divided We Govern, p. 37. 18 Jean Reith Schroedel, Congress, the President, and Policymaking: A Historical Analysis (Armonk, NY: M. E. Sharpe, 1994). 19 I limited my analysis to the years 1977-1996 for two primary reasons. First, I begin with the year 1977 to avoid any problems associated with the Watergate era. As many scholars have found, the years 1973-1976 pose a problem for studies regarding the president and Congress because of the impeachment process surrounding Richard Nixon, his subsequent resignation and the ascendency of Gerald Ford to the Oval Office. Second, the lists of legislation used to develop a sample of bills for this study do not include any data beyond 1996. As originally compiled, Mayhew’s list of important legislation stops with the 101st Congress (1989-1990). Edwards, Barrett, and Peake extended this list through 1992, the same year their list of failed legislation ends. Both of these lists were later extended through the 104th Congress (1995-1996) by George C. Edwards III and Andrew Barrett, “Presidential Agenda Setting in Congress,” in Jon R. Bond and Richard Fleisher, eds., Polarized Politics: Congress and the President in a Partisan Era (Washington, DC: Congressional Quarterly Press, 2000). No one has extended either of these two lists any further, however. 20 I eliminated a number of bills from Edwards, Barrett and Peake’s list of significant legislation that failed. The total number of bills excluded for the time period examined is 44. These bills were eliminated for a variety of reasons on a case-by-case basis. Some of these bills were mistakenly included in the original data set while others no longer seemed to merit inclusion in a list of potentially significant legislation after further analysis of how each of these proposals would have altered American policy. Plus, I added 4 other bills that were overlooked by Edwards, Barrett, and Peake. 16

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as bills which the president showed complete indifference, (and never publicly stated a preference).21 It is important to note that if the president opposed the current version of a given bill as it moved through the lawmaking process (and, perhaps, even threatened to veto that bill); but, he supported some alternative version of that legislation, these bills were included in my analysis. Thus, bills the president opposed in their current form that he wanted to alter are included in this study but bills the president simply wanted killed are not.22 In addition, I eliminated both treaties and treaty implementation legislation considered under fast track authority from both lists since these types of proposals do not follow the regular legislative process.23 Having eliminated some bills, I was left with 233 significant pieces of legislation to examine.24 For each bill from my sample, I coded its content in terms of what the president wanted in both chambers of Congress following three stages of the lawmaking process; in particular, the committee stage (including both subcommittee and full committee action), the floor vote stage (including congressional action during full chamber sessions), and the final passage stage (including conference committee action, the passage of the conference report by both houses, and any congressional action following a presidential veto).25 I coded the substance of legislation following these three stages; instead of merely the content of each bill in its final form, to develop a better picture of how the substance of legislation is used as a bargaining tool during the lawmaking process. To measure the content 21

The president’s position regarding each proposal examined (i.e., supported, wanted killed, or took no public position) was determined by using the legislative histories of each bill from Congressional Quarterly Almanac as well as any relevant remarks from the Public Papers of the Presidents. 22 For the time period examined, there were 84 bills that the president simply wanted killed and 32 bills regarding which the president took no public position. Of the former, 81 bills (or 96.4 percent) were eventually killed, indicating that when the president wanted a bill to fail, he usually received his legislative wish (whether he was responsible for defeating these bills or not). Some might argue that these 84 bills opposed by the president should be included in this study because the president’s ability to kill legislation is a form of presidential influence in the lawmaking process. I concede this point, yet the purpose of this article is not to examine all aspects of presidential influence in the legislative arena, only the president’s success in terms of the substance of legislation. Preventing bills he opposes from becoming law is outside the scope of this analysis. 23 There were 8 treaties or treaty implementation bills considered under fast track authority that were removed from the sample. 24 By examining the substance of legislation, it is possible to test the concept of the two presidencies (i.e., that presidents have more power in the defense and foreign policy arena than in domestic policy) as developed by Aaron Wildavsky, “The Two Presidencies,” Trans-Action 4 (1966), pp. 7-14. Even using the broadest definition of defense and/or foreign policy issues possible however, less than 10 percent of the bills from my sample can be fairly classified as defense and/or foreign policy issues. Thus, there were not enough of these proposals to make any valid comparisons with domestic policy proposals. To increase the number of defense and/or foreign policy proposals in my sample, I considered using a list of major foreign policy legislation created by Barbara Hinckley, Less Than Meets the Eye: Foreign Policy Making and the Myth of the Assertive Congress (Chicago, IL: University of Chicago Press, 1994). I chose not to use this data for several reasons. First, Hinckley only includes legislation that was brought to a vote on the floor of at least one chamber of Congress. This is a more stringent standard than Edwards, Barrett and Peake used to identify failed legislation. Second, Hinckley includes many proposals that may be considered important foreign policy initiatives, but that do not rise to the level of significance of the bills included in Mayhew’s and Edwards et al.’s lists. For example, she includes annual intelligence and State Department authorization bills. Third, there is a great deal of overlap between Hinckley’s list and the two lists used in this study. Consequently, adding Hinckley’s list of foreign policy legislation would only marginally increase the number of foreign policy bills examined. Finally, Hinckley’s list ends in 1991, meaning that this list of foreign policy initiatives does not include bills from 5 of the 20 years I examine. 25 Regarding twelve bills whose legislative histories were extremely complicated, I only examined the substance of legislation following the final passage stage.

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of legislation, I used the descriptions of the legislative history of each bill from Congressional Quarterly Almanac as well as any relevant presidential remarks included in the Public Papers of the Presidents. The descriptions from CQ Almanac were particularly helpful as they gave detailed information regarding the content of each piece of legislation as it moved through the legislative process as well as frequent references to the president’s position regarding the substance of each bill. Based on these legislative histories, I assigned a score indicating how much of what the president wanted was included in a given piece of legislation as it cleared each of the three lawmaking stages examined. In assigning a score, the substance of each bill as it was originally proposed was used as a baseline. The coding scheme adopted for the substance of legislation, and whether it was what the president wanted is as follows: 5 = the president received virtually everything he wanted (with the possible exception of only a few minor provisions opposed or not wanted by the president included) 4 = the president received most of what he wanted, yet he accepted a number of significant provisions he either opposed or did not want included 3 = the substance of a bill was a relatively equal compromise between the president and congressional leaders 2 = the bill contained a few significant provisions that the president wanted, yet the majority of the bill was not what he wanted 1 = the president supported passage of legislation to deal with a legislative issue, but the bill passed by Congress was nothing like what he wanted For the remainder of this article, this coding scheme is referred to as the presidential substance scale or as presidential substance scores. To help explain how coding decisions were made, here are a few specific examples of these decisions regarding four pieces of legislation included in this study: 1) During the 104th Congress (1995-1996), President Bill Clinton supported most of the substance of a House-passed bill to deal with illegal immigration, yet he opposed a few significant provisions including one that would have denied illegal immigrants access to public schools. Thus, the presidential substance score following the House floor vote stage for this bill was coded as "4". However, during the ensuing conference committee; congressional leaders, who wanted to pass a bill dealing with illegal immigration prior to the 1996 elections, altered the substance of the bill significantly in the direction of the president, including the removal from the bill’s final version of the provision regarding access to schools Clinton opposed. Consequently, although Clinton did not quite receive everything he wanted, the presidential substance score for this bill following the final passage stage was coded as a "5" since the president was the dominant winner in the battle over the content of this legislation. 2) Earlier in the same session of Congress, although Clinton supported portions of a Republican tax package (such as a smaller version of the child tax credits that was included); he opposed most of the proposal’s provisions. Since he was never able to significantly alter the content of this legislation (which he would eventually veto as

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Andrew W. Barrett part of a budget reconciliation bill), the presidential substance score following each stage of the legislative process in each chamber, except for the final passage stage since no tax legislation ever cleared this stage during this congressional session, was coded as a "2". 3) During the 102nd Congress (1991-1992), President George H.W. Bush strongly opposed the version of a civil rights bill approved by two House committees. However, since Bush was in support of an alternative civil rights bill, the presidential substance score following the House committee stage was coded as "1". In reaction to his objections, House leaders changed the substance of this legislation in the president's direction during the floor vote stage, yet Bush still opposed the House-passed version of this bill so the presidential substance score following the House floor vote stage was coded as "2". In October 1991, the president reached a compromise on the issue of civil rights with Senate leaders, a compromise that was passed by the entire chamber, and was largely adopted as the final version of the Civil Rights Act of 1991. Thus, the presidential substance score following both the Senate floor vote, and final passage stages was coded as "3". 4) During the 99th Congress (1985-1986), President Ronald Reagan opposed most of the provisions of a Democratic-controlled House version of an omnibus water projects bill which he threatened to veto while he supported most of the provisions passed by the Republican-controlled Senate in its version. Therefore, the presidential substance scores following the House and Senate floor vote stages were coded as "2" and "4", respectively. The final version of the water projects bill was a compromise between the House and Senate versions; and, as a result, the presidential substance score following the final passage stage was coded as "3,” representing a compromise between the president and congressional leaders.

These four examples demonstrate roughly how coding decisions were made; but, in most cases, CQ Almanac and the Public Papers of the Presidents provided more detailed information about the content of legislation than is presented here. For a handful of bills from each congressional session examined (approximately 2 or 3 per session), the description of the president's position in the sources used was quite vague. To deal with this issue, the following coding rule was adopted: if CQ Almanac (or the Public Papers of the Presidents) indicated that the president supported a bill in general, yet made no other reference to an administration's position regarding the various provisions of that bill, it was assumed that the administration was pleased with the basic makeup of that bill as it cleared each stage of the legislative process. The presidential substance score for such bills was coded as "5" after each legislative stage.26 26

Clinton’s first two years in office were particularly problematic. Specifically, for the 103rd Congress (1993-94), CQ Almanac frequently mentioned that Clinton supported a bill yet gave no other indication regarding the administration’s support for or opposition to specific provisions. In fact, CQ Almanac provided limited information regarding the president’s position for approximately 55 percent of the bills from the 103rd Congress included in this study. As a result, by adopting the coding rule that I would code as “5" the presidential substance score for any bill supported by the president regarding which I found no provisions objected to by the White House, the results for the 103rd Congress may be skewed if -- for whatever reason -- CQ Almanac was not very thorough in discussing Clinton’s objections. Based on the experience of coding the substance of over 200 pieces of legislation and the circumstances that existed during the 103rd Congress, it is my impression that for most of these bills that CQ Almanac did not discuss in

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The descriptions of the legislative histories of bills in CQ Almanac were usually very thorough in regards to the president’s position; and, thus, if an administration had a significant problem with a proposal at any point during the legislative process, CQ Almanac would probably have made a reference to it. If there was no mention of dissatisfaction with a bill from CQ Almanac (or the Public Papers of the Presidents); it may not always be a sign of absolute support. Consequently, some of the results that follow may be skewed toward the high end of the presidential substance scale.27 Nevertheless, for the vast majority of bills included in this article, I was able to find ample information regarding the substance of legislation and what the president wanted following each lawmaking stage. Despite any coding problems that existed, the findings presented in this article should represent a fairly accurate assessment of presidential success in terms of the content of legislation. Finally, a few words about the nature of the coding scheme are necessary. To code the substance of 233 diverse and complex pieces of legislation that dramatically varied in scope and subject matter following various stages of the legislative process, many subjective judgments needed to be made using a rather broad and somewhat imprecise coding scheme. Without a doubt, someone trying to replicate these decisions would make some different judgments. Regrettably, a second coder for these decisions was not possible due to the size of the project and limited resources. However, I have re-coded a number of these bills at different points in time to help verify the coding decisions made. More important, I relied very heavily on how CQ Almanac, an objective source, characterized the changes made to the substance of legislation throughout the lawmaking process. It also should be stated that I had no preferred outcome for the results at the beginning of this project since the findings from this study, no matter what they were, would be valuable since scholars have mostly neglected this research topic. Lastly, although this analysis is based on somewhat subjective coding decisions, subjective judgments under a defined coding scheme, even one as broad and imprecise as the one adopted here, need to be made if presidential scholars want to move beyond the realm of success rates and support scores to form a better understanding of presidential legislative success.

detail any presidential objections, Clinton probably had few. Why? The 103rd Congress was the first time in 12 years the Democrats controlled the White House and both chambers of Congress and, therefore, Clinton and congressional leaders were probably more concerned with passing legislation that had been bottled up by Republican presidents for over a decade, such as the ‘Motor Voter’ and ‘Brady’ bills, than fighting amongst themselves over minor provisions. In addition, it is likely that Clinton agreed with congressional leaders regarding the substance of most pieces of legislation as he and congressional leaders shared the same basic policy preferences. Finally, Clinton spent most of his first two years in office worrying about his first budget as well as his health care reform package and, thus, he might easily have deferred to congressional leaders on other bills. 27 It is obviously preferable if the results presented in this article were not skewed in any direction, yet it is better that the results are skewed toward the high end of the scale -- if they are skewed at all -- for the purposes of this study. Specifically, the main hypothesis examined is that presidents -- who operate with few formal powers in the legislative arena -- will be forced to bargain in terms of legislative content to secure passage of bills they support (particularly under divided government and regarding their own legislative initiatives). The lower the presidential substance scores, the more the presidents examined were forced to compromise. Thus, any skewing of the results toward the high end of the presidential substance scale that may exist is working in the opposite direction from the expected relationship, meaning that one can be confident that if the expected results are found that this is evidence of presidents needing to bargain and not the result of a skewed measure.

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EXAMINING THE SUBSTANCE OF LEGISLATION Are all presidential legislative successes really victories? The average presidential substance scores following each of the lawmaking stages examined are presented in Table 1. Table 1. The Substance of Legislation Following Three Stages of the Legislative Process

House Committee Stage

Senate Committee Stage

House Floor Vote Stage

Senate Floor Vote Stage

Final Passage Stage

Score Number of Bills 1 17 2 37 3 10 4 35 5 60 Average Score Following House Committee Stage 3.53 1 15 2 26 3 8 4 47 5 78 Average Score Following Senate Committee Stage 3.84 1 14 2 31 3 11 4 35 5 43 Average Score Following House Floor Vote Stage 3.46 1 10 2 22 3 11 4 43 5 47 Average Score Following Senate Floor Vote Stage 3.71 1 3 2 3 3 25 4 41 5 29 Average Score Following Final Passage Stage 3.89

Percent 10.7 23.3 6.3 22.0 37.7 8.6 14.9 4.6 27.0 44.8 10.4 23.1 8.2 26.1 32.1 7.5 16.5 8.3 32.3 35.3 3.0 3.0 24.8 40.6 28.7

The average presidential substance score following the final passage stage was 3.89. This number indicates that the president, as hypothesized, generally accepted a significant level of compromise to ensure that a bill he supported became law. The president received everything he wanted in terms of the substance of legislation regarding 28.7 percent of the bills examined. These findings support Neustadt’s notion that the president must bargain to influence the actions of other political actors. Nonetheless, even though the president bargained in terms of the substance of legislation, he still received most of what he wanted or more regarding approximately 69 percent of the bills that became law. Therefore, a solid

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majority of the presidential successes examined can be fairly characterized as legislative victories.28 Although the president was fairly successful regarding the substance of the 101 pieces of legislation examined that became law, 56.7 percent of the bills studied, each supported by the president, were eventually defeated. As a consequence, the president’s general success in terms of the substance of legislation should not be used as evidence that he was able to dominate the lawmaking process. On the other hand, only rarely was the president forced to accept a bill whose substance did not constitute at least a fair compromise from his perspective. Specifically, only six bills became law during the twenty years examined whose substance was not to the president’s liking (i.e., bills whose substance was coded as “2” or “1"). Regarding three of these bills, Reagan’s veto was overridden during his final two years in the White House.29 Reagan signed another of these bills, the Superfund Amendments and Reauthorization Act of 1986, although he was opposed to its legislative content because it was supported by a veto-proof majority in both congressional chambers. Finally, Reagan was able to secure passage of only a portion of his Caribbean Basin Initiative package as part of a supplemental appropriations bill in 1982, and Clinton’s $16.3 billion economic stimulus package was gutted before a portion of it became law in April 1993. Compared to the final passage stage, the president was not quite as successful in terms of the substance of legislation following the earlier legislative stages. As presented in Table 1, presidential substance scores following both the committee (3.53) and floor vote (3.46) stages in the House and the committee (3.84) and floor vote (3.71) stages in the Senate were lower than the substance score following the final passage stage (3.89). In addition, both chambers were far more likely to approve or pass legislation that the president disagreed with following the earlier lawmaking stages. In particular, while only 6 percent of the bills that became law were scored a "2" or lower on the presidential substance scale, more than 30 percent of bills cleared by House committees or passed on the House floor were coded as "2" or lower while more than 20 percent of the bills approved by Senate committees or passed on the Senate floor were coded as such. What do these differences between presidential substance scores following the final passage stage compared to the earlier stages of the legislative process demonstrate? There are 28

Although they supported all 233 bills included in this study, it is unlikely that the presidents examined put forth the same lobbying effort regarding each of these proposals. It is possible that the intensity of White House lobbying -- both publicly and privately -- has on impact on presidential success in shaping the substance of legislation. To measure the intensity of presidential lobbying efforts on behalf of the bills included in my sample, I used the average number of public remarks per month the president made in support of each of these proposals. This data was available from an earlier study I conducted on the legislative impact of presidential rhetoric. Andrew W. Barrett, “Gone Public: The Impact of Going Public on Presidential Legislative Success,” American Politics Research 32 (2004), pp. 338-370. Unfortunately, I only measured presidential rhetoric through the end of the first Bush administration in this study. Data was thus unavailable for the bills I examine here during the Clinton years. Nonetheless, the average number of presidential public remarks in support of the 70 bills in my sample that became law from Carter to Bush was 1.39 remarks per month. To determine whether the intensity of the president’s lobbying efforts had an impact on the substance of legislation, I compared the presidential substance scores following the final passage stage for the 24 bills that became law that the president publicly supported more than 1.39 times per month with the substance scores regarding the 46 bills that became law that the president publicly supported less than 1.39 times per month. Surprisingly, the substance scores for both sets of bills were quite similar, 3.63 for the bills the president publicly supported more than 1.39 times per month compared to 3.70 for the bills the president publicly supported less than 1.39 times per month. 29 These bills include the Water Quality Act of 1987, the Surface Transportation and Uniform Relocation Assistance Act of 1987, and the Civil Rights Restoration Act of 1987.

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a few possibilities. First, these statistics might suggest that during the final passage stage, where the threat of a presidential veto is most imminent, and the end of the lawmaking process is near, the president has more leverage with members of Congress than during the earlier stages of the lawmaking process. Simply, the president’s ability to shape the substance of legislation may be strongest during the final passage stage. Second, these numbers could simply indicate that the president does not normally become intimately involved in the lawmaking process during its early stages. With so many pieces of legislation being introduced each congressional session, the president may only choose to become engaged in legislative debates when a bill is close to reaching his desk. This explanation is consistent with Jean Reith Schroedel’s finding that presidential involvement during the early stages of policy formation is minimal.30 Another possible explanation for the higher average presidential substance score following the final passage stage may merely be that presidents are preventing legislation from becoming law whose substance they do not like during this stage. In other words, the higher presidential substance score following the final passage stage may be an indication that presidents do not alter the substance of legislation as much as prevent bills they do not like from becoming law. Based on the data, there is some truth to this assessment. When bills that did not become law are excluded from the analysis, the difference between the presidential substance score following the final passage stage, and the floor vote stages in both chambers is smaller. In particular, the average presidential substance score for bills that passed the House and the Senate but did not become law was 3.31 and 3.62, respectively. On the other hand, the average presidential substance score for the bills that became law was 3.53 following House passage and 3.76 following Senate passage. Nonetheless, even when bills that did not become law are excluded, the presidential substance score following the final passage stage (3.89) is higher than the scores following the floor vote stage in both chambers, indicating that the president is not simply preventing legislation he does not like from becoming law during the final passage stage, but that he also is successfully shaping the substance of legislation.

DIVIDED GOVERNMENT A comparison of presidential substance scores under unified and divided government is presented in Table 2. As hypothesized, the president receives more of what he wants in terms of legislative content when the government is unified and his party is in control of Congress than during divided government. Presidential substance scores under unified government range from 4.14 to 4.46 across the various stages of the legislative process whereas these scores range from only 2.76 to 3.70 under divided government. Based on these numbers, the presidents examined were undoubtedly more satisfied with the substance of legislation when Congress was controlled by their own party.

30

Schroedel, Congress, the President, and Policymaking.

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Table 2. The Substance of Legislation During Unified and Divided Government Following Three Stages of the Legislative Process Unified Government Divided Government Score No. of Bills Percent No. of Bills Percent 1 0 0 17 19.5 House 2 3 4.2 34 39.1 Committee 3 4 5.6 6 6.9 Stage 4 22 30.6 13 14.9 5 43 59.7 17 19.5 Average Score Following House Committee Stage: Unified 4.46 / Divided 2.76 t = 8.976** 1 1 0.9 14 24.6 Senate 2 12 10.3 14 24.6 Committee 3 4 3.4 4 7.0 Stage 4 39 33.3 8 14.0 5 61 52.1 17 29.8 Average Score Following Senate Committee Stage: Unified 4.26 / Divided 3.00 t = 4.350** 1 1 1.8 13 16.5 House 2 2 3.6 29 36.7 Floor Vote 3 3 5.5 8 10.1 Stage 4 20 36.4 15 19.0 5 29 52.7 14 17.7 Average Score Following House Floor Vote Stage: Unified 4.35 / Divided 2.85 t = 7.058** 1 1 1.2 9 17.3 Senate 2 8 9.9 14 26.9 Floor Vote 3 5 6.2 6 11.5 Stage 4 32 39.5 11 21.2 5 35 43.2 12 23.1 Average Score Following Senate Floor Vote Stage: Unified 4.14 / Divided 3.06 t = 3.224** 1 0 0 3 4.7 Final 2 1 2.7 2 3.1 Passage 3 4 10.8 21 32.8 Stage 4 18 48.6 23 35.9 5 14 37.8 15 23.4 Average Score Following Final Passage Stage: Unified 4.22 / Divided 3.70 t = 2.671** *

T-test for equality of means between presidential and congressional initiatives is significant at the .1 level ** T-test for equality of means between unified and divided government is significant at the .05 level

The president rarely signed legislation whose content he did not mostly support under unified government. In particular, 86.4 percent of the bills that became law were coded as "4" or "5" under unified government compared to only 59.3 percent under divided government. In addition, the legislative content of 32.8 percent of the bills that became law under divided government were coded as “3" indicating a relatively equal compromise between the president and congressional leaders, as opposed to only 10.8 percent under unified government. Clearly, the four presidents examined here accepted more legislative concessions when their party did not control both chambers of Congress. Five of the six bills that became

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law with a presidential substance score of “2" or lower also were from congressional sessions where the government was divided, again indicating the president’s weakened bargaining position under these circumstances.31 However, the president received everything he wanted in terms of legislative content regarding only 37.8 percent of the bills under unified government, suggesting that the president had to bargain with congressional leaders even when his party controlled both congressional chambers. As demonstrated by Table 2, the president was able to sign legislation into law under divided government that was largely to his liking. Even though the substance of legislation was generally not what the president wanted during the earlier stages of the lawmaking process under divided government (with presidential substance scores ranging from 2.76 to 3.06), the presidential substance score was significantly higher (3.70) following the final passage stage. When bills that did not become law are excluded, the presidential substance score following the final passage stage under divided government (3.70) is still higher than the substance scores for the House-passed (3.02) and Senate-passed (3.28) versions of these bills; providing evidence that the president played a role in shaping the substance of legislation at the final passage stage, even when his party did not control Congress. Nonetheless, across each of the various stages of the legislative process, the president was generally less satisfied with the substance of legislation under divided compared to unified government.32 The results presented in Table 2 also demonstrate an interesting difference in the nature of the two chambers of Congress which influences how large a role the president can play in the shaping of legislation. Following both the committee and floor vote stages, the differences between substance scores under unified and divided government are significantly higher in the House than in the Senate. In particular, the difference between substance scores under unified and divided government in the House is 1.70 following the committee stage and 1.50 following the floor vote stage. Comparatively, the difference between presidential substance scores under unified and divided government in the Senate is only 1.26 following the committee stage, and 1.08 following the floor vote stage. What do these numbers indicate? This data is probably reflective of the difference in rules between the two chambers. The structured nature of House rules allows the majority party leadership to have more control over its members than in the Senate where individual senators are not as limited in their legislative actions.33 This stricter House discipline seems to accentuate the difference between unified and divided government whereas the individual nature of the Senate weakens the ability of party leaders to run that chamber as a purely partisan institution. Certainly, partisanship plays a role in the Senate, yet, in terms of the substance of legislation, the legislative product produced in the Senate appears less partisan than the legislation produced by the House under divided government. 31

The only bill examined that became law under unified government with a presidential substance score of “2" or lower was Clinton’s economic stimulus package from the 103rd Congress (1993-1994). In this case, a Republican filibuster in the Senate was successful in preventing virtually all of the president’s proposals included in his package from becoming law, with the exception of a $4 billion emergency supplemental appropriation for extended unemployment benefits. “Fiscal 1993 Stimulus Bill Killed,” Congressional Quarterly Almanac, 1993 49 (1994), pp. 706-709. 32 This finding supports the claim that divided government matters, backing up the findings of Edwards, Barrett, and Peake, “The Legislative Impact of Divided Government” and others. 33 Ross K. Baker, House and Senate, 3d ed. (New York: W.W. Norton & Company, 2001).

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This assessment is supported by an examination of President Bush’s four years in office with a divided government. In particular, although Bush had a difficult time shaping the substance of legislation in the Democratic-controlled Senate, he had even less influence in the Democratic-controlled House of Representatives. In the Senate, the presidential substance scores during the Bush administration were 3.23 and 3.00 after the committee and floor vote stages, respectively. These low scores were significantly lower still in the House with presidential substance scores of 2.59 and 2.48 following the House committee and floor votes stages. Although he struggled to shape the content of legislation in the Senate, the House appeared to be the more partisan institution during Bush’s four years in office.

PRESIDENTIAL VERSUS CONGRESSIONAL INITIATIVES To determine the impact of who initiated a bill on legislative content, I divided my sample of legislation into presidential and congressional initiatives.34 Fifty-eight of the 233 bills examined were initiated by the White House while 146 of these bills were originally proposed by a member of Congress. The initiator of 29 bills in my sample was unclear, however. Bills that fell into this category include those regarding which the president and a congressman proposed similar legislation simultaneously; the president and a member of Congress proposed different bills that the relevant congressional committee/s combined into a larger piece of legislation; or the president and a congressman collaborated on a particular bill. Since an initiator for these 29 bills could not be identified, they were eliminated from this part of the analysis. The presidential substance scores for presidential and congressional initiatives following the five stages of the lawmaking process examined are presented in Table 3. As this table demonstrates, there is only a small and statistically insignificant difference between presidential substance scores when comparing presidential and congressional initiatives following the final passage stage. Specifically, the average presidential substance score for presidential initiatives is 3.80 following this stage compared to 3.96 for congressional initiatives. Granted, there are statistically significant differences between presidential and congressional initiatives following the earlier stages of the legislative process, yet it is the content of legislation as signed into law that matters most. Based on the numbers presented in Table 3, the presidents examined essentially were no more or less successful in terms of the substance of legislation depending on who initiated each bill.

34

The initiator of the bills in my sample was largely determined by Edwards and Barrett, “Presidential Agenda Setting in Congress.” These authors coded bills as presidential initiatives if the president introduced the original draft bill or a detailed set of proposals that formed the basis for congressional action. Bills introduced by members of Congress without a request from the president and without the assistance of the White House in the drafting process were coded as congressional initiatives. For a small number of the bills examined, the initiator was re-coded as additional information was used to correct any possible mistakes from the previous study.

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Presidential Initiatives

House Committee Stage

Score 1 2 3 4 5

No. of Bills 0 5 3 17 13

% 0 13.2 7.9 44.7 34.2

Congressional Initiatives No. of Bills 15 26 5 14 40

% 15.0 26.0 5.0 14.0 40.0

Average Score Following House Committee Stage: Pres. 4.00 / Cong.3.38 t = 2.261** Senate Committee Stage

1 2 3 4 5

0 3 2 18 17

0 7.5 5.0 45.0 42.5

13 21 4 21 54

11.5 18.6 3.5 18.6 47.8

Average Score Following Senate Committee Stage: Pres. 4.22 / Cong. 3.73 t = 1.995 House Floor Vote Stage

1 2 3 4 5

1 3 3 15 9

3.2 9.7 9.7 48.4 29.0

12 23 6 13 31

14.1 27.1 7.1 15.3 36.5

Average Score Following House Roll Call Stage: Pres. 3.90 / Cong. 3.33 t = 1.919 Senate Floor Vote Stage

1 2 3 4 5

0 3 2 17 9

0 9.7 6.5 54.8 29.0

10 15 6 19 34

11.9 17.9 7.1 22.6 40.5

Average Score Following Senate Roll Call Stage: Pres. 4.03 / Cong. 3.62 t = 1.475 Final Passage Stage

1 2 3 4 5

0 2 4 16 3

0 8.0 16.0 64.0 12.0

3 1 15 14 24

5.3 1.8 26.3 24.6 42.1

Average Score Following Final Passage Stage: Pres. 3.80 / Cong. 3.96 t = -.671 *

T-test for equality of means between presidential and congressional initiatives is significant at the .1 level ** T-test for equality of means between presidential and congressional initiatives is significant at the .05 level

Taking a closer look at presidential initiatives, Table 3 demonstrates that only 12 percent of these proposals that became law were coded as “5”, indicating that the president received practically everything he wanted in terms of legislative content. This statistic shows that the presidents examined almost always accepted some significant level of compromise to ensure that their proposals became law. This finding supports the hypothesis stated earlier that the initiator of a proposal will need to compromise to ensure passage of their legislation as well as Neustadt’s contention that presidents must bargain to influence other political actors,

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including members of Congress. Nonetheless, the presidents analyzed received most of what they wanted, as indicated by the presidential substance score of “4” regarding 64 percent of their proposals that became law, evidence that most presidential legislative successes are victories in terms of the substance of legislation. Regarding congressional initiatives, we find that congressional leaders accommodated presidential wishes to ensure that their proposals became law. In particular, the presidential substance scores for congressional initiatives increase from 3.38 and 3.33 following the committee and floor vote stages in the House; respectively, and from 3.73 following the committee stage and 3.62 following the floor vote stage in the Senate to 3.96 following the final passage stage. These figures suggest that congressional leaders were forced to compromise with the president during the final passage stage to secure his signature on their proposals. Even when bills that did not become law are eliminated, the presidential substance scores following the House (3.39) and Senate (3.74) floor vote stages are still lower than the substance score following the final passage stage (3.96). These results again support the hypothesis that the initiator of a bill will need to compromise in terms of legislative content (in this case, congressional leaders accommodated presidential wishes).

CONCLUSION What has been learned by examining the substance of legislation? First, the president generally accepted significant legislative concessions when he signed most of the bills examined (as indicated by the 3.89 presidential substance score following the final passage stage). This finding supports Neustadt’s contention that presidents must bargain to influence other political actors. Nonetheless, the president still received most of what he wanted in terms of the substance of legislation regarding 69.3 percent of the bills enacted into law. Therefore, most presidential legislative successes, at least those examined here, can be fairly characterized as presidential victories in terms of the content of legislation. In addition, only rarely was the president forced to sign a bill he strongly opposed or was a bill whose substance the president did not like become law over his veto. Presidential success in terms of legislative content was significantly reduced under divided government, however (although the president still frequently received much of what he wanted). Finally, although the president needed to make significant concessions regarding his proposals to secure their passage, congressional leaders often accommodated presidential wishes regarding their own initiatives. There are two important caveats to the results presented above. First, none of the findings presented demonstrate presidential influence in the lawmaking process, merely that the president was more successful in terms of the substance of legislation under certain circumstances. This lack of direct evidence regarding presidential influence in the legislative arena is common among studies seeking to measure presidential success in Congress, and this study does not correct for this shortcoming. Unless the preferences of members of Congress can be measured prior to presidential efforts to influence the substance of legislation, it is not possible to make any definitive statements about whether the president was able to shape the legislative content of the bills examined.

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Consequently, although this study fills a large gap in the current literature regarding presidential success in terms of the substance of legislation, and certain inferences can be made from the data presented, while no conclusive evidence is provided to demonstrate presidential influence in shaping the content of legislation. Second, are the measures of presidential preferences regarding legislative content used in this study reflective of the president’s true policy preferences or do they reflect strategic decisions made by the chief executive? Put another way, did the presidents examined reveal what they really wanted in proposing or supporting legislation or did they make calculated and/or anticipatory decisions to improve their chances of securing what they were looking for in terms of the content of legislation? Regrettably, the data presented above cannot answer this question either (as extensive archival research would be needed to determine the president’s true policy preferences regarding each of the 233 bills examined). However, previous studies indicate that presidents are generally sincere in the policy preferences they reveal to the public and members of Congress.35 In particular, based on more than 100 interviews with executive and legislative officials, Mark Peterson finds that presidents, who may have a firm position on an issue, who want to pursue good public policy and/or who may lack necessary information about congressional reactions to policy proposals, “have incentives to be quite sincere in the public announcement of their initiatives and to prefer to wage a campaign for their programs after initiation rather than temper them beforehand.”36 Nonetheless, before any definitive statements about the president’s success at shaping the content of legislation can be made, more research needs to be conducted regarding the nature of stated presidential policy preferences. Keeping these two caveats in mind, what are the implications from the findings presented here for the examination of presidential-congressional relations? As the data presented above indicate, there are clearly different types of presidential success in terms of the substance of legislation. Regarding some proposals, the president dominates the lawmaking process while he receives most, but not all, of what he wants concerning other bills. On other occasions, the president is either forced to accept an equal compromise with congressional leaders or sign a bill he largely disagrees with. Because of this variety, political scientists should incorporate the substance of legislation into their studies of presidential-congressional relations to obtain a more accurate measure of presidential legislative success. The legislative process is a very complicated one and presidential scholars should treat it as such. Simple success rates or support scores, while useful, are not sufficient measures of presidential success in Congress. Furthermore, presidents usually accept some level of compromise when they sign legislation into law while members of Congress usually alter their proposals to account for the wishes of the president. This finding raises several questions about the legislative process. How do changes in legislative content resulting from political compromises impact the quality and coherence of legislation enacted? In securing passage of legislation, are the president and congressional leaders sacrificing important provisions whose exclusion will 35

Kiewiet and McCubbins, “Presidential Influence on Congressional Appropriations Decisions”; Peterson, Legislating Together; Patrick J. Fett, “Truth in Advertising: The Revelation of Presidential Legislative Priorities,” Western Political Quarterly 45 (1992), pp. 895-920. 36 Peterson, Legislating Together, p. 43. Peterson also states that “there will be times when the president’s program is diluted as a result of consultation and executive estimates of congressional action” (p. 66). Thus, although the studies cited in the text indicate that presidents generally will be sincere in stating their policy preferences, even these studies leave room for the possibility of strategic and/or anticipatory decisions in terms of the announcement of presidential preferences.

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adversely impact the chances that a bill will fix the problem it was intended to solve? Or, do the compromises made throughout the lawmaking process improve the quality of the legislative product? If all legislation produced by the battles between the president and members of Congress is watered down for no other reason than political expediency, how effective is the American lawmaking process?

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 121-142

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

REVISITING EL DORADO CANYON: TERRORISM, THE REAGAN ADMINISTRATION, AND THE 1986 BOMBING OF LIBYA David B. Cohen and Chris J. Dolan ABSTRACT America’s current war on terrorism has led presidency scholars to revisit past U.S. antiterrorism measures. This study employs a case study approach to examine President Ronald Reagan’s decision to attack Libya in April 1986 as a national security response to terrorism. More specifically, it assesses the opportunities and constraints on presidential power with respect to terrorism, and stresses how political advisory group dynamics influence decision-making. It then analyzes several political dimensions that contributed to the eventual use of force, namely rising military tensions between the United States and Libya, as well as Libyan sponsorship of terrorist attacks. It also highlights the importance of key political factors within Reagan’s foreign policymaking process that shaped several options for the president including economic sanctions, non-lethal military pressure, and Operation El Dorado Canyon. The bombing of Libya also had far-reaching goals that went beyond responding to terrorism as Reagan also sought to influence the U.S.-USSR balance of power, and deter Iran and Syria from sponsoring future terrorist attacks. However, Reagan’s use of force should be interpreted as a limited military response since it did not halt Libyan terrorist attacks against the United States, and came at the same time as the Iran-Contra scandal, which greatly constrained, for the time being, executive power over American foreign policy.

INTRODUCTION At 7 o’clock this evening eastern time, air and naval forces of the United States launched a series of strikes against the headquarters, terrorist facilities, and military assets that support Mu’ammar Qadhafi’s subversive activities….Despite our repeated warnings, Qadhafi continued his relentless pursuit of terror. He counted on America to be passive. He counted

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wrong….I said that we would act...if necessary to ensure that terrorists have no sanctuary anywhere. Tonight, we have.1 With this speech, President Ronald Reagan announced to the world that the United States was prepared to use military means as a deterrent to future terrorist acts. The April 15, 1986 bombing of Libya was highly popular as 70 percent of Americans approved of the military strike.2 The Reagan administration had been threatening to use military force as a weapon against terrorism ever since Reagan was sworn into office. In fact, only a week after his inauguration, Reagan promised “swift and effective retribution” for terrorists. 3 Five years later, Reagan fulfilled his promise. However, the Reagan administration’s plans for a more consistent and powerful strategy against terrorism ceased not long after the bombing—the Iran-Contra scandal, which became public in November, 1986, paralyzed Reagan’s terrorism policy for the remainder of his second term. The September 11, 2001 attacks, and the recent U.S. military actions in Afghanistan and Iraq, have renewed academic and policymaker interest in understanding presidential efforts to combat terrorism. The purpose of this study is to strengthen an understanding of the political components of a president’s decision to use military force in response to terrorism. Recently, President George W. Bush emphasized that his long-term security objective is the destruction of terrorism, a goal to be achieved by the death or apprehension of terrorists, the destruction of their infrastructure, and support base, and retaliation against states that aid terrorists.4 Perhaps due to the magnitude and devastation of the attacks on the World Trade Center and the Pentagon, the G.W. Bush administration, unlike the Reagan administration, does not plan to initiate limited strikes in response to individual attacks. President Bush has in fact promised to eradicate terrorism from where it currently exists and to attack any and all states that protect and finance terrorist networks. Therefore, the differences between Reagan and Libya, and Bush and global terrorism are great. Assessing the options and objectives within Reagan’s foreign policy process that structured his decision to use force against Libyan terrorism is the central theme of this case study.

TERRORISM AND PRESIDENTIAL POWERS The U.S. Constitution grants Congress authority to declare war and other powers with respect to the armed forces. The president has explicit authority to serve as commander-inchief. Most presidential scholars agree the president can use military force in the absence of 1

“Address to the Nation on the United States Air Strike Against Libya: April 14, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), pp.468-469. 2 George J. Church, “Hitting the Source,” Time, 28 April 1986, p.26. 3 “Freed American Hostages,” Weekly Compilation of Presidential Documents 17 (2 February 1981): 50. 4 Perhaps the most well-known of all of Bush’s speeches on this topic is the 2002 State of the Union speech in which Bush discussed the “axis of evil”: “We will work closely with our coalition to deny terrorists and their state sponsors the materials, technology, and expertise to make and deliver weapons of mass destruction. We will develop and deploy effective missile defenses to protect America and our allies from sudden attack. And all nations should know: America will do what is necessary to ensure our nation's security. We'll be deliberate, yet time is not on our side. I will not wait on events, while dangers gather. I will not stand by, as peril draws closer and closer. The United States of America will not permit the world's most dangerous regimes to threaten us with the world's most destructive weapons.” “President Delivers State of the Union Address: January 29, 2002.” Available at: http://www.whitehouse.gov/news/releases/2002/01/20020129-11.html. Retrieved October 8, 2003.

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congressional approval in order to “repel sudden attacks” against the citizens and property of the United States5 In other circumstances, presidents must seek formal legislative consent before using military force.6 For much of American history, presidents have respected Congress’s war powers.7 However, during the Cold War, the president was preeminent in the political system, and his position as commander-in-chief increasingly overwhelmed Congress leading many scholars to speak of an imperial presidency.8 Since the end of World War II, presidents have broadly interpreted their powers to make war and use military force. As Congress consented to presidential supremacy in U.S. foreign policy at the height of the Cold War, it established a precedent for deferring to the executive branch.9 This was standard practice until the passage of the War Powers Resolution in 1973, designed to limit the power of presidents to use military force. and to resurrect Congress’s role in the deployment of combat troops abroad. The legislation stipulates that presidents “should consult with Congress in every possible circumstance,” both before and after the use of military force.10 Specifically, the president must notify Congress in writing within 48 hours after he uses force, and must seek Congress’s formal approval within 60 days of the operation. If Congress disapproves, the president is forced to withdraw U.S. forces. The employment of U.S. armed forces abroad has been a catalyst in the growth of presidential power and has, at times, strained relations between the executive and legislative branches. While the War Powers Resolution was clearly a response to expanded presidential war powers in the wake of Korea and Vietnam, all presidents since its passage have claimed it violates the president’s power as commander-in-chief.11 Moreover, Congress is hard pressed to enforce it, as it would appear unpatriotic to refuse support for military action once initiated by the president. However, the War Powers Resolution represents a major symbolic effort at congressional reassertion, and does complicate the president’s ability to use force abroad unilaterally.12 In response to terrorism, and to specific terrorist threats, presidents have used military force, and justified such actions as fully within their constitutional powers.

5

For an assessment of the presidential literature concerned with executive’s war-making powers, see David Gray Adler, “The Constitution and Presidential War-making,” Political Science Quarterly 103 (1988): 1-36. See also Charles A. Lofgren, “War-making Under the Constitution: The Original Understanding,” Yale Law Journal 81 (1972) 6 See: Barry Blechman and W. Philip Ellis, The Politics of National Security: Congress and US Defense Policy (London: Oxford University Press, 1995); Rebecca KC Hersman, Friends and Foes: How Congress and the President Really Make Foreign Policy (Washington, DC: The Brookings Institution, 2000); James M. Lindsay, Congress and the Politics of US Foreign Policy (Baltimore, MD: Johns Hopkins University Press, 1994); Robert J. Spitzer, President and Congress: Executive Harmony at the Crossroads of American Government (Philadelphia. PA: Temple University Press, 1992), Chapter 4. 7 Francis D. Wormuth and Edwin B. Firmage, To Chain the Dog of War. (Urbana: University of Illinois Press, 1989). 8 E.g., see Arthur M. Schlesinger Jr., The Imperial Presidency (Boston: Houghton Mifflin, 1973). Interestingly, many commentators are recalling the imperial presidency in light of the G.W. Bush administration’s response to the 9/11 attacks. See, e.g., Bruce Shapiro, “Restoring the Imperial Presidency,” Salon.com, June 27, 2002 [available at http://www.salon.com/politics/feature/2002/06/17/bush_watergate/] and Linda Greenhouse, “The Imperial Presidency and the Constraints of the Law,” New York Times, April 18, 2004. 9 Louis Fisher, Presidential War Power. (Lawrence: University Press of Kansas, 1995). 10 Public Law 93-148. 11 Louis Fisher, Presidential War Power. (Lawrence, KS: University Press of Kansas, 1996). 12 The impact of the 1973 War Powers Resolution appears to be mixed. As Richard Grimmett of the CRS held, “Some observers contend that the War Powers Resolution has not significantly increased congressional participation, while others emphasize that it has promoted consultation and served as leverage.” See Richard F.

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In 1980, following the 1979 seizure of the U.S. embassy in Tehran by Islamic followers of Ayatollah Khomeini, President Jimmy Carter, in the absence of congressional consultation, ordered a military rescue operation that ultimately failed in the Iranian desert.13 Years later, during his first term in office, President Bill Clinton ordered a military strike against Iraq after uncovering evidence linking Iraqi intelligence agents to a plot to assassinate former President George H.W. Bush in Kuwait.14 Clinton again used force in 1998; this time against targets in Afghanistan and Sudan, in response to terrorist attacks coordinated by the Al-Qaeda terrorist network against U.S. embassies in Nairobi, Kenya and Dar es Salaam, Tanzania.15 While Congress supported these retaliatory strikes, it balked at the White House failure to adhere to the War Powers Resolution.16 President Reagan’s level of consultation with Congress prior to the Libya bombing was somewhat unique. In January 1986, Reagan submitted Executive Order 12543, which decreed that a state of emergency existed between the United States and Libya. After that, the president did not petition Congress for an authorization to use force, justifying his actions as commander-in-chief, which he claimed were unquestioned.17 However, the issue of war powers was first raised on March 24, when Libyan forces fired missiles at U.S. aircraft operating in the Gulf of Sidra. In response, the U.S. fired missiles at Libyan vessels in defense of the U.S. naval presence in the gulf. Subsequently, on April 5, a terrorist bombing of a discotheque in West Berlin occurred, and an American soldier was killed. On April 14, President Reagan announced there was irrefutable evidence that Libya had been responsible, and U.S. Air Force planes commenced bombing strikes on headquarters, terrorist facilities, and military installations in Libya in response. The President reported both terror attacks cases to Congress although the report on the bombing did not cite section 4(a) (1) of the War Powers Resolution and the Gulf of Sidra report did not mention the War Powers Resolution. Since the actions were short lived, there was no issue of force withdrawal, but senators introduced bills to amend the War Powers Resolution. S.J. Res. 340 called for improving consultation by establishing a special consultative group in Congress, and an anti-terrorism bill demanded specific cooperation between the president and Congress on authorizing force in response to terror attacks was introduced.18

Grimmett, “War Powers Resolution: Presidential Compliance.” Congressional Research Service Issue Brief for Congress, March 24, 2003. Available at: http://fpc.state.gov/documents/organization/19134.pdf. 13 In fact, Secretary of State Cyrus Vance resigned in protest of Carter’s failure to notify Congress in advance of the military operation as well as National Security Adviser Zbigniew Brzezinski’s dominance of Carter’s foreign policy agenda. For more, see Robert A. Strong, Working in the World. (Baton Rouge: Louisiana State University Press, 2000). 14 George Stephanopoulos, All Too Human (A Political Education). (Boston: Little Brown and Company, 1999). 15 For an excellent study of global terrorism and its impact of US interests, see Walter Landers and Todd Sandler, “Transnational Terrorism in the Post-Cold War Era.” International Studies Quarterly 43 (1999). 16 For an excellent analysis of how the Republican Congress criticized Clinton’s foreign policy in general and his decision to use force against Al-Qaeda in the absence of congressional support, see: Reihan Salam, “Guide to the Iraq Debate,” The New Republic, October 13, 2003. 17 Steven V. Roberts, “Attack on Libya: The View From Capital Hill,” New York Times, April 15, 1986, 17. 18 S.J.Res. 340 was introduced on May 8, 1986. It was not acted upon although the proposal was later incorporated in other proposed amendments. The Anti Terrorism bill, formalized as S. 2335 and H.R. 4611 and introduced on April 17, 1986, was never acted upon.

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PRESIDENTIAL DECISION-MAKING Empirical research on presidential foreign policy advisory systems assists our examination of President Reagan’s decision to attack Libya. Richard E. Neustadt advances the concepts of backward mapping and forward planning to aid us in the understanding of presidential foreign policy advisory systems. Backward mapping involves the president and his advisers’ level of confidence that his decision will produce a desired political result. Put simply, how will the president’s decision facilitate the attainment of his political objectives? A president formulates effective decisions when he believes the opportunity to act has arrived, and his advisers will determine the steps needed to maximize the results.19 Therefore, it is important to consider Neustadt’s backward mapping concept since it allows both scholars and policymakers to discern how President Reagan estimated the effects of a U.S. military strike on disrupting terrorist attacks against U.S. citizens and property. Forward planning involves the president’s management of the foreign policy process, and how it promotes the attainment of his established objectives. The president and his advisers must be constantly aware of the domestic and international political consequences of a decision to use force; and to consider any available information and advice that may alter the decision’s goals. However, forward planning is highly problematic, given the array of domestic political pressures on presidents to act.20 For example, why did Reagan attack Libya while trading arms for hostages with Iran at the same time? Similarly, Alexander L. George contends that case studies of particular events, such as presidential decision-making and foreign policy advisory systems, must be contextual. He advances four principles, in order to develop a discriminatory assessment of individual cases. First, George delineates that presidential decision-making involves trade-offs between policy quality, the need for support from others, and the need for timely action. A president is often faced with deciding how much of their political capital and resources should be spent in order to obtain a higher quality decision. Second, a thorough examination of the problems, information, and available options immediately prior to identifying choices is not always necessary to make a sound decision. A president must establish limits, and define the parameters within which the development of choices takes place. Third, effective decisions can be made in the absence of unity within the president’s inner circle. A president can have a poorly constructed or flawed foreign policymaking process, and rely on personal or organizational resources between his advisory groups to strengthen his decisions. Finally, presidents do not always consult with their advisers in order to receive information and advice; he must have an incentive to consult, which is of course circumstantial.21 A president’s personality and management style directly affects the structure of his advisory groups, and the array of options available to him.22 19

Richard E. Neustadt, Presidential Power: The Politics of Leadership. (New York: John Wiley, 1960). Ibid. Alexander L. George, “From Groupthink to Contextual Analysis of Policymaking Groups.” In Paul 't Hart, Eric K. Stern, Bengt Sundelius, Eds. Beyond Groupthink: Political Group Dynamics and Foreign Policymaking. (Ann Arbor, MI: University of Michigan Press, 1997), 44 – 50. 22 Alexander L. George, Presidential Decision-making in Foreign Policy: The Effective Use of Information and Advice. (Boulder, CO: Westview Press. 1980); Fred I. Greenstein, The Hidden Hand Presidency: Eisenhower as Leader. (New York: Basic Books, 1982); Richard Tanner Johnson, Managing the White House: An Intimate Study of the Presidency. (New York: Harper and Row, 1974). 20 21

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Of course, research has demonstrated that presidential management style can also affect the parameters of president-adviser relations, influence small group characteristics, and shape the political roles played by advisers in establishing options for the president.23 Jean A. Garrison argues that a more open and undisciplined advisory system provides key foreign policy advisers, especially the secretary of state and the national security adviser, with equally consequential status with respect to the president, enabling them to compete with one another and effectively promote their favor policy alternatives in decision-making. In her study of Secretary of State Cyrus Vance and National Security Adviser Zbigniew Brzezinski in the Carter administration, Garrison observes that the open and undisciplined system contributed to significant policy differences over specific issues, which produced what she describes as “an all-out framing war” that weakened the ability of the president to direct his own foreign policy program. Her findings are particularly significant to the study of the Reagan administration’s use of force against Libya, since the organization of the president’s foreign policy advisory system has a direct influence on policy outcomes.24 Moreover, presidential preferences for policy choices will determine how the president processes advice from subordinates, and how his advisory structures and institutions coordinate issues in the greater policymaking process.25 As noted by Stephen Hess, President Reagan preferred to convey, “general goals…letting his subordinates work out the details.”26 Reagan White House Counsel Peter Wallison described the president’s management style as one focused on broad ideological goals, in which specific policy decisions were delegated to his staff. Wallison argues that these very same qualities permitted the devastation wrought by the Iran-Contra affair.27 Reagan himself described his advisory system in the following way: “You surround yourself with the best people you can find, delegate authority, and do not interfere as long as the overall policy that you have decided upon is being carried out.”28 Reagan’s worldview also influenced the ability of his advisers to identify policy options. As demonstrated by Betty Glad, Reagan frequently used simple-minded analogies, stereotypes, and enemy-images to ongoing events in both foreign and domestic affairs.29 While this limited Reagan’s options, it enabled him to act decisively, although at times hastily, on such foreign policy issues as global terrorism and the Soviet Union. Overall, presidential decisions are sharply defined by pressures that complicate the attainment of the president’s goals. Most of the time, presidents decide quickly how to 23

Graham Allison, Essence of Decision (Boston: Little, Brown, 1971); Jean A. Garrison, Games Advisers Play (College Station, TX: Texas A & M Press, 1999); Margaret G. Hermann and Thomas Preston, “Presidents, Advisers, and Foreign Policy; The Effect of Leadership Style on Executive Arrangements,” Political Psychology 15 (1): 75 – 96; Thomas Preston, The President and His Inner Circle (New York: Columbia University Press, 2001); Thomas Preston, “Following the Leaders?: The Impact of U.S. Presidential Style Upon Advisory Group Dynamics, Structure, and Decision.” In Paul t’Hart, Eric Stern Bengt Sundelius, Eds. In Beyond Groupthink: Political Group Dynamics and Foreign Policymaking (Ann Arbor, MI: University of Michigan Press, 1999), 191-248; Jerel A. Rosati, The Carter Administration’s Quest for the Global Community: Beliefs and Their Impact on Behavior (Columbia, SC: University of South Carolina Press, 1982). 24 Jean A. Garrison, “Framing Foreign Policy Alternatives in the Inner Circle: President Carter, His Advisors, and the Struggle for the Arms Control Agenda,” Political Psychology 22, 4 (2001): 775-807. 25 Stephen Hess, Organizing the Presidency. (Washington DC: Brookings, 1988); Johnson, Managing the White House. 26 Hess, Organizing the Presidency, 143. 27 Peter Wallison, Ronald Reagan: The Power of Conviction and the Success of his Presidency (New York: Westview Press, 2002). 28 Reagan’s description of his management style and organizational preference can be found in Ann Reilly Dowd, “What Managers can Learn from Manager Reagan,” Fortune. September 15, 1986, 36. 29 Betty Glad, “Black and White Thinking: Reagan’s Approach to Foreign Policy,” Political Psychology. 4: 33 – 76.

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respond to threats, surprises, and unexpected terrorist actions.30 Presidents must also be aware of their foreign policy objectives, management style, worldview, national security strategy, and relations with U.S. allies and coalitions. Furthermore, presidents have to be mindful of the domestic political context that structures whether or not a decision will be made. The exercise of what is perceived to be strong presidential leadership ultimately influences the degree of success in persuading others to fall in line.

THE REAGAN ADMINISTRATION FOREIGN POLICY APPARATUS In order to investigate how the decision to bomb Libya was made, it is necessary to examine the components of Reagan’s foreign policy process. Ronald Reagan came into office committed to cabinet style government. Witnessing the paralyzing problems of his predecessor, Reagan downgraded the role and prestige of the national security adviser position while upgrading the role of his cabinet officials. From the start, however, it appeared that Reagan’s national security process would fare no better than Carter’s. His first assistant for national security affairs, Richard Allen, was ineffective and not perceived as a team player. After allegations of financial wrongdoing, Allen was fired and replaced by Reagan’s friend William Clark in 1982. Although Clark had little experience in national security matters, he succeeded in bolstering the prestige of the national security adviser position. Clark then left his post for another cabinet position in 1983, and was succeeded by Robert McFarlane. Although technically much more competent than Clark, McFarlane never enjoyed the same access to the President that Clark had.31 McFarlane resigned in December 1985, and was succeeded by Vice Admiral John Poindexter, his deputy on the NSC staff. Reagan’s first Secretary of State, Alexander Haig, was surprisingly vocal and critical of Reagan’s foreign policy process. He frequently clashed with Richard Allen and Secretary of Defense Caspar Weinberger over who was the primary foreign policy adviser to the president.32 After Haig was dismissed in 1982, he was succeeded by George Shultz who held the position for the remainder of the Reagan presidency. As time wore on, Reagan relied upon Shultz increasingly as a foreign policy adviser. Their counterpart was Secretary of Defense Caspar Weinberger, an old Reagan friend. Although Weinberger lacked much of the technical expertise required for such a position, he enjoyed great access to the President. In 1986, the NSC/Principals Committee consisted of the statutory members: VicePresident George H.W. Bush, Secretary of Defense Weinberger, and Secretary of State Shultz. Other critical members of Reagan’s foreign policy team included Assistant for National Security Affairs Poindexter, Chief of Staff Donald Regan, and Director of Central Intelligence William Casey. The foreign policy apparatus at that time was characterized by the strict control of Chief of Staff Donald Regan. Regan acted as a filter through which access to the President was

30

George, Presidential Decision Making in Foreign Policy, chapter 8; Richard E. Neustadt, Presidential Power: The Politics of Leadership (New York: John Wiley and Sons, 1960); Preston, The President and His Inner Circle. 31 E.g., see John P. Burke, The Institutional Presidency: Organizing and Managing the White House from FDR to Clinton, 2nd Edition (Baltimore: The Johns Hopkins Univ. Press, 2000) and Hess, Organizing the Presidency. 32 Godfrey Sperling, “Reagan’s Problems with the Press,” Christian Science Monitor, November 16, 1981.

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tightly managed and involved few people.33 However, even with this tight command by Regan, the process tended to be disordered and tumultuous. In part, the reason for this is due to Reagan’s management style as he delegated authority to a fault. Instead of being in the center of foreign policy decisions and evaluating information on the subject at hand, Reagan preferred to remain at the periphery and to let his policy advisers analyze information and derive policy options.34 The NSC was not a dynamic body in which policy options were analyzed and decisions were hammered out. Instead, it was an institution decaying from lack of innovation. In a September, 1986 interview Reagan commented about his Cabinet meetings: “I use a system in which I want to hear what everybody wants to say honestly...I encourage all the input that I can get...and when I’ve heard all that I need to make a decision, I don’t take a vote. I make the decision.”35 This rather idealized view by Reagan has been discounted by many who served under him and who study him. Especially after Donald Regan became chief of staff; and streamlined the chain of command, open and substantive debate involving the President was not a regular part of the agenda.36 A Time article highlighted this situation at the White House in 1986: “In two years as chief of staff, Donald Regan has kept most of such controversy [open debate and disagreement] away from the President. Regan generally mediates the battles and presents the President with sanitized position papers that give little hint of the cacophony outside.”37 Regan had his share of troubles with other members of the White House staff. His relationship with Reagan’s national security advisers was shaky at best. Some posit that McFarlane’s departure in December 1985 was in part due to Regan. A U.S. News & World Report article asserted as much: The exit of McFarlane did not surprise insiders. Friends say he was physically exhausted and becoming frustrated by the president’s disinterest in the analytical briefings that were his specialty. Despite denials by both McFarlane and the President, sources also made clear that he resented what he saw as the chief of staff’s meddling in his area and attempts to choke off 38 access to the Oval Office.

The informality of the Reagan national security apparatus in turn resulted in pockets of independent and unscrupulous action. Vice-Admiral Poindexter, and his predecessor Robert McFarlane, transformed the NSC staff into a clandestine policy-making and policyimplementing body. The Iran-Contra scandal actively promoted and executed by the NSC

33

Ann Reilley Dowd, “Learning From Reagan’s Debacle,” Fortune, 27 April 1987, p.170. E.g., Donald T. Regan. For The Record: From Wall Street to Washington (New York, NY: Harcourt Brace Jovanovich, 1988); see also Burke, The Institutional Presidency and Hess, Organizing the Presidency. 35 Ann Reilley Dowd, “What Managers Can Learn From Manager Reagan,” Fortune, 15 September 1986, p.36. 36 E.g., see David B. Cohen, “From the Fabulous Baker Boys to the Master of Disaster: The White House Chief of Staff in the Reagan and G.H.W. Bush Administrations,” Presidential Studies Quarterly Vol.32, #3 (2002) September, pp.463-83 and David B. Cohen, Chris J. Dolan, and Jerel A. Rosati, “A Place at the Table: The Emerging Foreign Policy Roles of the White House Chief of Staff” Congress & the Presidency Vol.29, #2 (2002). 37 George J. Church, “Is He More Out of Touch Than Ever,” Time, 26 January 1987, p.17. 38 William L. Chaze et al., “White House Shake-Up,” U.S. News & World Report, 16 December 1985, p.20. 34

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staff, was by far the biggest embarrassment of the Reagan administration and in effect incapacitated Reagan’s foreign policy for the remainder of his term.39 The problems stemmed in large part from the way Reagan designed his foreign-policy machinery. Determined to avoid the conflicts that raged between the State Department and the National Security Council under Jimmy Carter, Reagan downgraded the NSC from a policymaking and control group to little more than a funnel for policies generated by the strong-minded secretaries. Reagan also favored conservative ideology over ability or experience in filling foreign-policy slots, particularly at the NSC.40 For all the control Regan tried to assert on the other members of Reagan’s team, the administration was besieged by internal squabbles from the first term. Shultz and Weinberger rarely agreed on any subject. A key issue on which both advisers continued to strongly disagree was over the deployment of military force in Lebanon in the wake of the terrorist attacks on the U.S. Marine barracks in October 1983. Schultz argued vehemently that the Marines should have remained in place, and that any retreat from Lebanon would be a sign of weakness. Weinberger opposed the contined military presence, arguing in favor of an immediate withdrawal and against the use of retaliatory force. Although Weinberger and the Joint Chiefs of Staff convinced President Reagan to order the withdrawal, any hope for cooperation between Schultz and Weinberger had deteriorated. Another issue on which each adviser sparred was U.S.-Israeli relations. Weinberger was resistant to closer relations between the two nations; whereas Schultz, National Security Adviser William Clark, and President Reagan himself were among Israel’s stronger supporters.41 The tension between Shultz and Weinberger was further aggravated by the rivalry between the departments of State and Defense. Brian Davis asserted that it was Reagan’s weakness that allowed the bickering of Cabinet officials to continue unabated, and thus Reagan’s foreign policy became prostrate. He commented that: Secretary of State Shultz and Secretary of Defense Caspar W. Weinberger disagreed on most serious policy issues, compounding their long-standing personal antipathy.…The most fundamental problem was the passivity of a president whose interest in foreign affairs was known to be weak, [and] his failure to referee among factions and impose decisions upon 42 them.

Even President Reagan stated that there were problems between his Secretary of State and Secretary of Defense: “Cap Weinberger and George Shultz never got along especially well together. There was always a little chill—a tension—between them.”43

39

E.g., see Lou Cannon, President Reagan: The Role of a Lifetime. (New York: Public Affairs, 2000). Lawrence E. Walsh and Patrick C. Walsh, Firewall: The Iran-Contra Conspiracy and Cover up. (New York: WW Norton and Company, 1997). 40 David Alperin, “Who Makes US Foreign Policy?” Newsweek, November 9, 1981, 32. 41 For more on the conflicting relationship between Schultz and Weinberger on these and other issues, see: Bernard Gwertzman, “Schultz’s Address Touches Off Stir in Administration.” New York Times 26, October 1983, p.1. See also Jeffery Record, “Weinberger-Powell Doctrine Doesn’t Cut It” U.S. Naval Institute Proceedings 126, no. 10, October 2000, p.35. 42 Brian L. Davis, Qadhafi, Terrorism, and the Origins of the U.S. Attack on Libya (New York: Praeger, 1990), p.62. 43 Reagan, p.511.

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On one subject Shultz and Weinberger agreed: Iran-Contra. From the start both men opposed the secret arms sales to Iran, and both felt that the NSC staff and Regan were not protecting the President. Reagan asserted as much in his memoirs: “while George and Cap disagreed on many topics, they were united on one thing: Almost from the day Bud McFarlane brought us the proposal for arms sales to Iran, they were against it.”44 Caspar Weinberger’s criticism of the NSC staff on the subject of Iran-Contra is especially poignant: The President was misled and badly served by Robert McFarlane and some of his staff who should never have been appointed to the White House staff, and who were completely unwilling to recognize their own severe limitations of intellect, or moral principles, or any real understanding of history….I always expressed the most vigorous opposition, as did Secretary 45 Shultz, to the whole plan.

So what exactly are the images of Reagan’s foreign policy apparatus in 1986? The system, which in theory is to be run by the President, appears to be one of informality to the point of disarray. Reagan was passive and detached, delegating much of his authority to subordinates. Chief of Staff Regan attempted to assert complete control over the national security network, thus positioning himself as a buffer between Reagan and other policy advisers. Although the role of the national security adviser was downgraded from the start, both McFarlane and Poindexter operated independently in making policy decisions. What appeared to be a weakened role for the national security adviser and his staff, is in essence quite the opposite—a national security adviser and a NSC staff frequently out of control.46 We are thus left with a picture of disorganization and chaos pervading the Reagan White House. For all of Reagan’s criticisms of the Carter presidency, the Reagan administration’s national security apparatus fared little better.

THE REAGAN ADMINISTRATION, QADHAFI, AND TERRORISM: 1981-1985 From day one, the Reagan administration was forced to confront the growing problem of terrorism. The lessons of the Carter administration’s losing battle against terrorism were well known. The hostage crisis, which began on November 4, 1979, crippled the last year of Jimmy Carter’s presidency as he was unable to resolve the crisis and bring home the hostages. The failed April 1980 hostage rescue attempt marked the nadir of the Carter presidency. The apparent helplessness and frustration of the Carter administration’s attempts to secure the release of the Embassy hostages did not go unnoticed by Reagan. In early speeches, he vehemently denounced terrorism and promised a more aggressive and effective counterterrorism policy. The Reagan administration started on an emotional high as all 52 U.S. hostages were released by Iran minutes after Reagan was sworn into office. This would be the pinnacle of 44

Reagan, p.512. Weinberger, pp.353-373. 46 Although it has not been discussed here, Director of Central Intelligence William Casey was a major figure in Reagan’s national security network as well. E.g., see Bob Woodward, Veil: The Secret Wars of the CIA 19811987 (New York: Simon & Schuster, 1987). 45

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the Reagan administration’s campaign against terrorism. Over the next eight years, U.S. citizens from Beirut to Berlin, El Salvador to Zimbabwe found themselves victims of heinous terrorist acts. Table 1 provides a brief chronology of major terrorist incidents involving Americans that occurred during the Reagan administration’s first term.47 Table 1: Major Terrorist Incidents Involving Americans, 1981-1986 April 18, 1983 October 23, 1983

December 12, 1983 September 20,1984 November 20, 1984

December 3, 1984

June 14, 1985 June 19, 1985 August 8, 1985 October 7, 1985 November 23, 1985

December 27, 1985

U.S. Embassy in Beirut is blown up by a van packed with explosives; 63 people killed, 17 Americans dead The headquarters of the U.S. Marine Battalion Landing Team in Beirut is blown up by a truck packed with explosives; 241 Americans killed. Suicide squads attack U.S. and French embassies in Kuwait; five people are killed A van carrying explosives detonates outside of the U.S. Embassy annex in Christian East Beirut; two U.S. servicemen are killed A truck bomb exploded outside the Aukar, Lebanon annex of the U.S. embassy in Beirut. Twenty-four people are killed including 2 U.S. military personnel Kuwait Airways Flight 221 from Kuwait to Pakistan was hijacked and diverted to Tehran. Two passengers who were U.S. government employees were murdered TWA Flight 847 is hijacked en route to Rome; one U.S. Navy diver is murdered Six Americans (four U.S. Marines and two American businessman) are murdered outside a café in San Salvador, El Salvador A car bomb explodes outside the U.S. Rhein-Main Air Base near Frankfurt, Germany killing two Americans Italian cruise liner, the Achille Lauro, is hijacked off the coast of Egypt; one American passenger is murdered Egypt Air Flight 648 enroute from Athens to Cairo is hijacked to Malta. During the rescue operation, 60 passengers are killed including one American Terrorists simultaneously attack Rome and Vienna airport ticket counters; 20 people murdered, 5 Americans

THE REAGAN ADMINISTRATION AND QADHAFI: A ROUGH BEGINNING From inauguration day, it was obvious that Reagan and Libyan leader, Mu’ammar Qadhafi, would have difficulties. With the new administration, there came a new outlook on 47

The information for this chronology was extracted from David C. Martin and John Walcott, Best Laid Plans, (New York: Harper & Row, 1988), pp.xv-xx.

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Libya. Jimmy Carter’s policy toward Libya embodied increasing displeasure with Qadhafi and a decline in relations; Reagan’s policy was immediately hostile and condemnatory. Seven months after taking office, Reagan faced the first of many challenges by Qadhafi. In August 1981, the U.S. Navy’s Sixth Fleet was taking part in maneuvers in the Gulf of Sidra. For years Qadhafi had claimed that the Gulf, which is nestled between two northern Libyan promontories, was his “lake” and was not to be considered international waters. Officially, these maneuvers were routine naval exercises in international waters. Unofficially, the positioning of the Sixth Fleet was a ploy by the Reagan administration to provoke Qadhafi. On August 19, two Libyan SU-22s fired on two American Navy F-14s 30 miles off the coast of Libya. The Libyans missed their targets and were subsequently shot down by the Navy fighters.48 Following this episode, Qadhafi was so enraged he vowed to assassinate Reagan and other U.S. diplomats. This further confirmed what the administration already suspected: that Qadhafi was insane. Caspar Weinberger, Secretary of Defense, said of Qadhafi: Qadhafi is a theatrically posturing, fake mystic, with a considerable dollop of madness thrown in. Rumors have long circulated in intelligence circles that he suffers from an incurable venereal disease, and that the disease accounts for occasional bouts of madness exhibiting 49 hysteria, braggadocio and extreme theatricalism.

President Reagan, in response to a reporter’s question at a news conference, said of Qadhafi, “how can you not take seriously a man that has proven that he is as irrational as he is on things of this kind [terrorism]. I find he’s not only a barbarian, but he’s flaky.”50

1985: 3 Terrorist Incidents Push Reagan into Action Terrorism was heating up in 1985. As the publicity and attention for acts of terrorism increased, so did the pressure on the Reagan administration to respond. Three events were particularly important in eliciting a tougher response from the administration. The hijacking of TWA Flight 847 on June 14 was the first of these critical events. In a highly publicized affair, a Lebanese Shiite group, Hezbollah, hijacked Flight 847 en route to Rome from Athens. One American Navy diver was murdered; and his body was thrown out on to the tarmac for millions of television viewers to see. The affair lasted over two weeks, and the ostensible helplessness of the Reagan administration to deal with the situation invoked images of Jimmy Carter. The crisis eventually ended without any further loss of life. Surprisingly, this was accomplished with the help and intervention of Syrian leader Hafez Assad. Following the crisis, Reagan instructed Vice-President Bush to head a task force to investigate terrorism and possible counter-terrorist responses.51

48

Davis, p.47. Caspar W. Weinberger, Fighting For Peace (New York: Warner Books, 1990), p.175. 50 “The President’s News Conference: January 7, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), p.21. 51 Martin and Wolcott, pp.161-202. 49

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The hijacking of the Italian cruise ship, the Achille Lauro, was another troubling episode for the Reagan administration. Shortly after setting sail from Alexandria, Egypt on October 7, 1985, the cruise-liner was commandeered by four armed gunmen affiliated with the Palestinian Liberation Front, and headed by Abu Abbas, a known terrorist kingpin. The crisis lasted three days and resulted in the murder of an elderly American, Leon Klinghoffer, who was shot in the head and chest by one of the terrorists. The crisis was defused after the terrorists were given a get-away plane and the rest of the passengers were set free. Again, the Reagan administration seemed powerless; however, a secret plan to intercept the hijacker’s plane in the air was devised by Vice-Admiral John Poindexter, a member of the NSC staff, and approved by Reagan.52 The hijacker’s plane was intercepted successfully by U.S. Navy fighters, and forced to land at Sigonella, Sicily. After a three way standoff between Italian, American, and Egyptian forces, the terrorists were handed over to the Italian government.53 The interception was highly popular in the United States, and gave the country hope that the administration could effectively combat terrorism. President Reagan was particularly upbeat: Events of the past 24 hours reinforce the determination of all of those who share the privileges of freedom and liberty to join together in countering the scourge of international terrorism...[America has] sent a message to terrorists everywhere. The message: you can run 54 but you can’t hide.

The excitement for the administration was short lived, however. On December 27, in one of the most grisly incidents in recent times, 20 innocent people were gunned down at airport ticket counters in Rome, Italy, and Vienna, Austria, in simultaneous attacks.55 Five of the dead were Americans, including an 11 year-old girl who was shot in the head at point-blank range. As networks broadcast the gruesome scenes on television, the event sent a shock wave through the American public. The Abu Nidal terrorist organization was implicated in the massacres and a Libyan link was suspected. Not only was it well known that Qadhafi was one of Nidal’s biggest sponsors, Libya praised the airport massacres as “heroic operations.”56 Also, Tunisian passports that were confiscated or stolen by Libyan authorities from Tunisian workers in Libya were found on the terrorists after the airport attacks.57

52

Poindexter would later become national security adviser under President Reagan and it is thought that the plan helped Poindexter to secure the job when Robert McFarlane stepped down. 53 Martin and Wolcott, pp.235-257. 54 “Remarks and a Question-and-Answer Session With Reporters: October 11, 1985,” Public Papers of the Presidents of the United States: Ronald Reagan, 1985, Book II, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), pp.1231-1232. 55 There was disagreement in the Administration concerning what U.S. reaction to the airport massacres should have been. Many in the Administration, such as Shultz and the NSC staff, favored an immediate retaliatory strike on Libya. Others, including Reagan, Weinberger, and the JCS, felt that the evidence was not solid enough to unequivocally prove a Libyan connection. Absent a smoking gun, Reagan opted to try economic sanctions and wait for a better opportunity to use the big stick. See Davis, p.82., Martin and Wolcott, p.274., & Hersh p.19. Another event that occurred in response to the airport massacres was the almost immediate response of the Administration in drawing up contingency plans. Although there is dispute as to which agency or policy-making body was responsible for this, contingency plans were nevertheless started in early January, 1986. See Davis, p.82., Weinberger, p.188., & Hersh, p.48. 56 Davis, pp.78-79. 57 Martin and Wolcott, p.268.

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OPTIONS AND OBJECTIVES Economic Sanctions Shortly following the brutal incidents in Rome and Vienna, Chairman of the Joint Chiefs of Staff Admiral William J. Crowe initiated contingency plans for a military strike against Libya in the event that the President ordered a military response.58 Reagan himself recalls that, following the airport massacres, the United States “couldn’t ignore the mad clown of Tripoli any longer. By now, we had a shelf full of contingency plans designed to express in a concrete way our displeasure with his terrorism.”59 Vice-President Bush’s task force on terrorism endorsed the use of military force as a way of combating terrorism. The report, which was made public in February, 1986, stated: When perpetrators of terrorism can be identified and located, our policy is to act against terrorism.…We are prepared to act in concert with other nations, or unilaterally when necessary, to prevent or respond to terrorist acts. A successful deterrent strategy may require 60 judicious employment of military force to resolve an incident.

Libya would indeed be the main target of the administration’s war on terrorism. Because of the evidence the United States had obtained that Qadhafi was implicated in the airport massacres, Libya became the primary target of U.S. counter-terrorism efforts. It was, however, necessary to take a preliminary step, short of military action, in order to initiate this counter-terrorism policy. On January 7, 1986, President Reagan signed Executive Order 12543 which called into effect a national emergency with respect to Libya, and instituted stiff economic sanctions. Among other things, E.O. 12543 prohibited trade with Libya (with certain exceptions for humanitarian goods or publications), and ordered all U.S. citizens and companies to leave there as soon as possible.61 In discussing the reasons for the economic sanctions, Reagan pointed toward Qadhafi’s connection to the Rome and Vienna massacres, and his tacit support of Abu Nidal and other terrorist organizations: The Rome and Vienna murders are only the latest in a series of brutal terrorist acts committed with Qadhafi’s backing. Qadhafi and other Libyan officials have publicly admitted that the Libyan Government has abetted and supported the notorious Abu Nidal terrorist group, which was directly responsible for the Rome and Vienna attacks. Qadhafi called them heroic actions, 62 and I call them criminal outrages by an outlaw regime.

58

Davis, p.81. Ronald Reagan, An American Life (New York: Simon and Schuster, 1990), p.511. 60 “Public Report of the Vice President’s Task Force On Combating Terrorism,” (Washington, DC: USGPO), February 1986, p.9. Available at: http://www.population-security.org/bush_and_terror.pdf. 61 “Executive Order 12543-Prohibiting Trade and Certain Transactions Involving Libya: January 7, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), pp.14-15. 62 “The President’s News Conference: January 7, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), p.17. 59

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Officially, the administration had the view that economic sanctions would deter Libya from any further support of terrorism. Unofficially, sanctions appeared to be a formality opening the door for a military response. Martin and Wolcott asserted that “the sanctions were only a first step. Having got them out of the way, [Deputy National Security Adviser] Donald Fortier said, people will step up to more forceful actions.”63 Implicit in Reagan’s comments on the sanctions was that the United States would consider the military option if Qadhafi did not curb his sponsorship of terrorism. Reagan hinted that he would take military action when he threatened that “if these steps do not end Qadhafi’s terrorism, I promise you that further steps will be taken.”64 Another reason for instituting economic sanctions was to buy time in order to get U.S. nationals out of Libya. It was thought at the time that there were upwards of 1000 Americans in Libya at the beginning of 1986. If any military action were taken against Libya before those citizens had left, Qadhafi would have ample opportunity to kidnap and use them for political purposes. Reagan acknowledged that this was a factor in his imposing economic sanctions and subsequently ordering all Americans to leave Libya: “whatever we did [in terms of a response to the airport massacres], we had to take into account the presence of nearly one thousand American oil workers in Libya. Qadhafi wouldn’t think twice about taking his vengeance on them.”65 Other reasons why Reagan initially opposed a military strike on Libya, and instead opted for economic sanctions included the possibility of killing Libyan and other civilians; killing Soviet advisers; American fighters being shot down, and/or the possibility that an American fighter pilot would be captured; responses of other Arab governments and peoples; retaliation by terrorists; and, world opinion.66 Ultimately, economic sanctions failed to alter Qadhafi’s behavior and the fact that Europe did not institute sanctions did not help matters. Since terrorism was as much a European problem as it was an American problem, the administration had hoped that Western European nations would help isolate Libya. Instead, because of economic self-interest and fears of terrorist reprisals, countries such as Great Britain and France refused to break economic ties with Qadhafi. The vacuum that was left in Libya when U.S. companies departed was quickly filled by nations clamoring for an easy profit. Only one month after U.S. sanctions were instituted, France struck a secret deal with the Libyans to sell them Exocet anti-ship missiles, aware that those missiles may be used against U.S. naval forces.67 This action by Europe was in defiance of Reagan who commented during his announcement of economic sanctions that: Qadhafi deserves to be treated as a pariah in the world community. We call on our friends in Western Europe and elsewhere to join with us in isolating him. Americans will not understand 68 other nations moving into Libya to take commercial advantage of our departure.

63

Martin and Wolcott, p.276. “The President’s News Conference: January 7, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), p.18. 65 Reagan, p.511. 66 Davis, p.82. 67 Davis, p.102. 68 “The President’s News Conference: January 7, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), pp.17-18. 64

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Operations in the Vicinity of Libya Following the initiation of economic sanctions, the Reagan administration decided to send the Sixth Fleet back to the Gulf of Sidra.69 This move was officially intended to reassert America’s right of passage in international waters. Unofficially, the Operations in the Vicinity of Libya (OVL), as it was known, was intended to taunt Qadhafi and to show U.S. resolve in the face of Libyan threats.70 The military operations began in late January, 1986, and consisted of three phases with each phase designed to up the ante of confrontation. The first phase began near the end of the month and resulted in 14 encounters between United States and Libyan aircraft. The second phase took place between February 12 and 15 and resulted in over 160 encounters between United States and Libyan fighters.71 In the third phase of OVL, labeled Operation Prairie Fire, U.S. naval forces erased Qadhafi’s so-called “line of death” (parallel 32o30’ north latitude).72 Pushing ever closer toward Libya, the administration finally got Qadhafi to react. At 3:00 p.m., on March 23, Libyan forces fired 2 SA-5 missiles at U.S. planes. With Qadhafi initiating hostilities, the United States was able to respond in kind under the aegis of self-defense. The U.S. Navy proceeded to knock out Libyan radar stations and several attack boats. The United States suffered no casualties, while Libya lost dozens of military personnel.73 Had any American serviceman been killed, the United States was prepared to respond with overwhelming force against military and possibly economic targets on the Libyan mainland.74 Polls showed the American public supported the Navy’s actions in the Gulf with a whopping 75 percent approval rating.75 Following the incidents, President Reagan telephoned Vice Admiral Frank Kelso, the Commander of the Sixth Fleet, and congratulated him for sending “a message to the whole world that the United States has the will and...the ability to defend the free world’s interests.”76 The confrontation in the Gulf of Sidra, however, did not deter Qadhafi from further acts of terrorism. Less than two weeks later, on April 5, a bomb exploded in the West Berlin discotheque, the La Belle, a known hangout for American military personnel. Three people

69

Following the Rome and Vienna airport massacres, Ronald Reagan approved the Navy show of force, the Operations in the Vicinity of Libya (OVL). See Davis, p.82. 70 E.g., see Tim Zimmerman, “The American Bombing of Libya,” Survival, vol.29 (May/June 1987), p.204. 71 Martin and Wolcott, pp.278-279. 72 Reagan approved Operation Prairie Fire, the third stage of OVL, sometime in mid-March. Both Davis and Weinberger assert that Reagan’s decision to approve Prairie Fire occurred at a NSPG meeting March 14, 1986; see Davis, p.103, and Weinberger, p.182. There is evidence that in discussing the rules of engagement for the upcoming Prairie Fire operation, there was a serious disagreement concerning level of force. Some in the Administration, including Shultz and the NSC staff, wanted a disproportionate response on Libyan mainland targets if Qadhafi attacked the Sixth Fleet. Others including Weinberger and Crowe called for a proportional response in which the United States would respond tit-for-tat against Libyan military targets. A compromise was worked out in which the United States would only respond in kind unless any U.S. personnel were killed, in which case a U.S. strike on Libyan military, political, and economic targets would ensue. See Seymour M. Hersh, “Target Qadhafi,” New York Times Magazine, 2 February 1987, p.71., & Davis, p.103. for more details. 73 Richard Stengel, “Sailing in Harm’s Way,” Time, 7 April 1986, pp.16-24. 74 Davis, p.103. 75 Robert Oakley, “International Terrorism,” Foreign Affairs, (America and the World 1986), p.616. 76 “Remarks by Telephone to Vice Admiral Frank B. Kelso II, Commander of the United States 6th Fleet: March 27, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), p.407.

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were killed including two U.S. servicemen, and over 250 people were injured.77 British intelligence services had intercepted and decoded messages before and after the incident from Libya linking it to the bombing. The evidence was damning and the Reagan administration had its “smoking gun.”78 This incident, coupled with the explosion three days earlier on board TWA Flight 840 in which four Americans were killed, greatly increased the pressure on the administration to act in a forceful way against Libya.79

Operation El Dorado Canyon Ronald Reagan recalled that shortly following the La Belle disco bombing, he immediately decided on a more lethal military response.80 He asserted: I felt we had no alternative but a military response: As a matter of self-defense, any nation victimized by terrorism has an inherent right to respond with force to deter new acts of terror. I felt we must show Qadhafi that there was a price he would have to pay for that kind of 81 behavior, that we wouldn’t let him get away with it.

Caspar Weinberger similarly recalled the decision to strike Libya being made shortly after the La Belle bombing. He stated that after messages were intercepted linking Libya to the bombing, “we had our proof. And so we [the Reagan administration] decided to give the focused response to terrorism that we had always planned to deliver when our proof was clear.”82 Operation El Dorado Canyon began on April 14, as 29 USAF F-111’s and 28 USAF refueling tankers took off from bases in Great Britain. It took a great deal of arm-twisting to convince British Prime Minister Margaret Thatcher to allow the F-111’s based in the U.K. to be used.83 After weeks of publicly stating that a U.S. retaliatory strike against Libya would be in violation of international law, Thatcher finally agreed to permit the use of those fighters stationed in Britain. Ultimately, Reagan convinced Thatcher that a retaliatory strike against Libya, specifically aimed at terrorist support facilities while avoiding civilian areas, would indeed be self-defense. Thatcher was quoted as saying such a military attack would be “fully

77

Oakley, p.617. Davis, pp.115-116. 79 There was, however, little evidence that Libya was responsible. Martin and Wolcott, pp.285-286. 80 The decision to bomb Libya was made following the La Belle discotheque bombing. The evidence, it was felt by Reagan, was irrefutable, and thus he decided quickly to commence with Operation El Dorado Canyon. In fact, Weinberger stated that following the La Belle bombing, Reagan was “anxious to do the attack as soon as all was ready.” Weinberger p.190. Although it is unclear at exactly what point Reagan decided to go ahead with the operation, it appears that he decided on April 5 or 6, shortly following the presentation of evidence from the La Belle attack. See Reagan, pp.518-519., Weinberger, p.190., Hersh, p.74., & Davis, p.119. Davis contends that Reagan tentatively agreed on April 6 and signed a National Security Decision Directive on April 9. 81 Reagan, p.518. 82 Weinberger, p.188. Following the La Belle bombing, Reagan received widespread approval from his advisers to strike at Libya. If there was dissent, it was not expressed. This is significant as this was the first time Reagan had unanimous support to initiate a military strike on Libya, and thus the pressure to act must have been enormous. It is evident that in the absence of Cabinet support, Reagan would have pressed ahead with El Dorado Canyon. See Davis, p.119., & Weinberger, p.188. 83 William R. Doerner, “In the Dead of the Night,” Time, 28 April 1986, p.28. 78

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consistent with the right of the United States to defend itself under the inherent right of selfdefense recognized in Article 51 of the United Nations Charter.”84 Early in the morning of April 15, the F-111’s rendezvoused off the coast of Tunisia with a U.S. Navy armada consisting of 18 A-6 and A-7 strike and strike-support planes, six F/A-18 fighters, and 14 EA-6B electronic jamming aircraft as well as numerous other naval support planes. The F-111’s were forced to fly an extra 2400 miles round-trip because France and Spain refused to grant over-flight rights over their respective territories.85 French President Francois Mitterrand added insult to injury when he reportedly advised the American military attaché in Paris, who submitted the over-flight request, that the United States should go all out and “not do a pinprick.”86 Shortly before 2:00 a.m. Libyan time (7:00 p.m. EDT), the U.S. fighters approached their targets. Thirteen of the Air Force F-111’s proceeded to bomb targets in Libya’s capital city Tripoli, while twelve Navy A-6 attack bombers struck simultaneously at targets near the coastal city of Benghazi which lies across the Gulf of Sidra opposite Tripoli. The attack lasted just over eleven minutes, and resulted in substantial damage, some of it collateral. Of the targets in Tripoli, Sidi Bilal, a naval commando school, the military side of Tripoli International Airport, and the Bab al Azziziyah Barracks, Qadhafi’s home, and command and control center, were heavily damaged. Qadhafi’s eighteen month-old adopted daughter was reportedly killed, and several other members of his family were injured. Qadhafi himself was apparently shaken but relatively unharmed. U.S. officials denied that the targeting of the Azziziyah Barracks was an attempt to assassinate Qadhafi; however, it is unclear whether this was indeed the case. Benghazi targets also suffered great damage as a military barracks, and several Soviet-made Libyan jet-fighters were destroyed. The United States suffered two casualties in the strike as one of the F-111’s crashed off the coast of Tripoli killing both crew members. Tripoli also suffered much civilian damage and many civilian casualties as at least one of the 2000 pound bombs used in the raid went astray from its target, crashing into a populated area.87 It has been reported that upwards of 100 Libyans, most of them military personnel, were killed during the strike.88 Two days after the action, three previously kidnapped westerners (two Britons and one American) were found slain in Lebanon in apparent retaliation for the U.S. bombing.89 From the start, the Reagan administration called the action a resounding success. The implicit message of the bombing was that the United States would not back down from repeating such an action if it had evidence that Libya or other states were sponsoring terrorism. The day after the raid Reagan said: Yesterday the US won but a single engagement in the long battle against terrorism. We will not end that struggle until the free and decent people of this planet unite to eradicate the scourge of terror from the modern world...We would prefer not to have to repeat the events of

84

Martin and Wolcott, p.290. Doerner, pp.28-29. 86 Martin and Wolcott, p.293. 87 Doerner, pp.28-31. 88 Edward Schumacher, “The United States and Libya,” Foreign Affairs, (Winter 1986/1987), p.335. See also Frederick Zilian, Jr., “The U.S. Raid On Libya-and NATO,” Orbis, (Fall 1986), pp.509-510. 89 “Chronology 1986,” Foreign Affairs, (America and the World 1986) p.674. 85

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last night. What is required is for Libya to end its pursuit of terror for political goals. The 90 choice is theirs.

Why not Iran or Syria? The problems the Reagan administration experienced with Libya with respect to terrorism lead one to question why Iran or Syria were not seriously considered as primary targets for the administration’s military retaliation option. At the time, Iran and Syria were viewed as the two biggest supporters of Middle East terrorism. Why then did the United States not seriously consider punishing these two international pariahs as well as or instead of Libya? There are several possible explanations for this. First, both Syria and Iran had more military power than Libya, and were not only better equipped, but also better trained. The United States experienced this fact first hand after a botched air raid on Syrian anti-aircraft positions in Lebanon on December 4, 1983. The operation cost the Navy two planes, and the life of one pilot.91 Iran’s military, after years of fighting a brutal war with Iraq, would have been more experienced than Libya’s.92 Also, Iran and Syria were much more populous than Libya. Their combined populations amounted to over 45 million people compared to 3.5 million people for Libya. If the United States were to have been dragged into a prolonged conflict, this fact would have been very important. Both countries were also strategically more important to the Soviet Union. Especially in the case of Iran, military action so close to its border risked Soviet intervention, and possible escalation. More important, concurrent with the United States bombing of Libya, the Reagan Administration was pushing ahead with its Iran initiative. The initiative was an attempt by the administration to forge new links with moderates in the Iranian parliament and cabinet. It was an attempt to head off Soviet meddling in Iran’s internal affairs pending the eventual, and, what was thought at the time, imminent death of the Iranian spiritual and political leader Ayatollah Khomeini.93 It was also part of an effort to influence Iran to help secure the release of U.S. hostages being held in Lebanon in exchange for American weapons and military equipment. As Reagan’s troubles with terrorism were heating up in the 1984-1986 period, his Iran initiative was gaining momentum. Engaging in military reprisals against Iran at the same time the United States was selling arms to the Iranians would have been counterproductive. The Reagan Administration was also hoping for better relations with Syria. Hafez Assad’s intervention on behalf of the hostages in the TWA 847 episode was a positive first step. A military strike on Syria would have eliminated any Syrian thoughts of opening up to the West following the TWA 847 episode. In addition to these reasons, the fact that Qadhafi had been a thorn in Reagan’s side ever since he took office made Libya the most attractive candidate for the United States to 90

“Remarks at a White House Meeting With Members of the American Business Conference: April 15, 1986,” Public Papers of the Presidents of the United States: Ronald Reagan, 1986, Book I, (Washington, DC, Office of the Federal Register, National Archives and Records Administration), p.472. 91 Martin and Wolcott, pp.141-144. 92 Although Libya had been waging war on and off with Chad for years, its forces were not as experienced as Iran’s.

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experiment with its new hard line counter-terrorism policy. Not only was Qadhafi viewed as a madman, Libya was particularly vulnerable to political, economic, and military pressures. Politically, Qadhafi was increasingly isolated from his Arab allies and the Soviet Union. Economically, Libya was completely dependent on oil exports. The drop in oil prices in the 1980’s coupled with U.S. economic sanctions and potential sanctions from Europe put Libya’s economy at the mercy of the Western powers.94 Finally, as was mentioned before, Libya’s armed forces were amateurish; its pilots were not trained to fly at night, and its navy consisted of a few patrol boats.

Shifting the American-Soviet Balance of Power In striking at Libya, Reagan believed he succeeded in bringing about a more favorable Soviet-American balance of power thereby enabling his administration to act with greater freedom and decisiveness around the world, according to Secretary of State Shultz. For Shultz, the new balance and assertiveness were also reflected in unfolding events on the Honduran-Nicaraguan border where Reagan airdropped U.S. troops in March 1986. However, Reagan was sure to add that the two events were not tied together by any new grand strategy.95 According to Reagan, the operation against Libya was planned in advance to make a point about Libyan involvement with terrorism and freedom of navigation on the high seas. The emergency arms aid to Honduras was the product of opportunity presented by the surprise Nicaraguan operation across the Honduran border, although it allowed the president to highlight his Administration’s desire to aid anti-Communist insurgencies throughout the world, and especially in Latin America. Senior officials at the NSC maintained that the administration was in a position to make these points because there was little the Soviet Union could do or was willing to do about it. Thus, to Reagan, the administration could afford to be more assertive.96 Taken together, the military strike against Libya, and covert pressure on Nicaragua, plus such efforts as stepped-up covert aid to Afghan rebels, framed a new American stance in the world that emerged as a consistent feature of the Reagan presidency. It is an assertiveness that grew directly from Reagan’s critique of Jimmy Carter. However, as administration officials acknowledge, Reagan’s actions evolved more from an attitude of confidence and optimism about having the Soviets on the run. A senior administrative official said: “It is not a national strategy, in part, because Congress does not agree with it.”97 Even to a number of officials who applauded them, the Libya and Honduras actions represented raw demonstrations of power rather than invitations to diplomacy and negotiations. In both cases, Reagan’s advisers made clear their conviction that there was not much to negotiate with Libya and the Sandinista leadership. While most administration officials were careful not to make bold statements that the strikes were likely to curtail Libyan 93

John Tower, Edmund Muskie, and Brent Scowcroft, The Tower Commission Report (New York: Bantam Books & Times Books, 1987), p.20. 94 Zimmerman, p.198. 95 See: George P. Shultz, Turmoil and Triumph: Diplomacy, Power, and the Victory of the American Ideal. (New York: Macmillan publishing, 1993). 96 David Shipler, “Trying to Use the Military as a Diplomatic Strategy,” New York Times, March 30, 1986, 1. 97 Quote can be found in Leslie Gelb, “Policy Struggles By US and Soviet Union on Verge of a Shift,” New York Times, April 5, 1986, 1.

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terrorist activities, Secretary of State Shultz insisted that the attacks sent a bold message that “terrorism is going to pay a cost” and dismissed critics who suggested that the United States may have unleashed anti-American sentiment in the Arab world and strengthened Qadhafi’s hold on power.98 If there was any consensus in the administration, most felt Qadhafi would be more likely to increase these activities. Similarly, few believed that the Sandinista Government would be cowed into concessions as a result of American posturing in Honduras. They, too, might increase their operations if they can.99 In both instances, however, officials contended that Reagan wanted to send a longer-term message, namely, that both Libya and Nicaragua should worry more about what the United States might do next, and should understand that Moscow cannot be counted upon for support. From the outset of his administration, Reagan was prepared to dispatch American forces to trouble spots around the globe and provide covert aid to rebels fighting Soviet troops or Soviet-backed regimes.100 However, while Reagan’s rhetoric was strong, his actions were generally cautious since the Soviet Union was a militarily superpower. In time, however, senior officials came to feel that their arms buildup was forcing the USSR into real problems of economic stagnation at home and overextension of commitments abroad.101 President Reagan was of the belief that military action against Libya, and American involvement in Honduras, had Moscow on the defensive. As a result, the United States could be somewhat more venturesome in challenging Soviet interests with less risk of a serious Soviet response. Thus, there were the open and strong military challenges to Soviet client states. This was done directly with American military power in Libya, and on the assumption officials said, that Moscow would do little in response, save to protest and portray Washington as an aggressor.102 Despite the billions of dollars in arms sales from Moscow to Tripoli, U.S. intelligence agencies never expected that the Soviet Union would take serious risks to defend Qadhafi.

FINAL THOUGHTS Although there was a significant internal debate concerning United States policy toward Libya from the very beginning of Reagan’s presidency, following the events of 1985 and early 1986, a consensus evolved within the administration approving of the use of military force to teach Qadhafi a lesson. This is not to purport that all of the administration’s officials were on friendly terms with each other. Rather, it is to suggest, that at least on this particular issue, a consensus was arrived at within Reagan’s national security apparatus and eventually acted upon. Furthermore, although the temporary goals of retaliation, retribution, and the temporary disturbance of Libyan-sponsored terrorism were attained, the bombing of Libya certainly did 98

Robert A. Manning, “The Raid: Was it Worth It?” US News and World Report, May 5, 1986, 18. Frederick Kemp and Robert S. Greenberger, “Policy Test: Events in Libya and Nicaragua Aid Reagan at Least Temporarily,” Wall Street Journal, March 26, 1986, 1. 100 See Gerald M. Boyd, “Reagan Accuses Soviets of Aiding Latin American Terrorists in Nicaragua,” New York Times, February 2, 1986, A1; David Shipler, “US and Soviet Union are Talking Sotto Voice,” New York Times, March 9, 1986, 3. 101 Leslie Gelb, “Reagan’s Maneuvers,” New York Times, April 27, 1986, 1. 102 Robert Toth, “Soviets are Quieter on the Third World Front,” Los Angeles Times, July 29, 1986, A4. 99

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not result in a long-term cessation of Libyan terrorism. Perhaps no incident illustrates this more than the explosion of Pan Am Flight 103 on December 21, 1988 over Lockerbie, Scotland, killing all 259 passengers and crew and 11 on the ground.103 Then, on September 19, 1989, a French DC-10 exploded over Chad in the Sahara Desert killing 170 people. Libya has been linked to both cases and has agreed to pay the families of the victims in both tragedies.104 We can therefore conclude that Operation El Dorado Canyon did not permanently disrupt Libyan sponsored terrorist activities. In the end, the American people saw the bombing of Libya in 1986 as a prudent and forceful move in America’s war on terrorism that certainly did not halt future terrorist attacks by Libya against the United States. Whether the bombing achieved the objective Reagan sought is open to debate. The United States bombing of Libya provides scholars with an opportunity to reexamine Reagan’s foreign policy process as well as U.S. terrorism policy in general—an especially relevant and important task in a post-9/11 world.

103

In 1999, the two suspects were turned over by Qadhafi to an international tribunal in the Hague, as a sign of cooperation in exchange for economic aid from the European Community. In August of 2003, Libya agreed to pay families of the victims of Pan Am 103 $2.7 billion. At the end of 2003, Libya agreed to end its nuclear program in hopes of normalizing relations with the West. See Edward Alden and Roula Khalaf, “Dealing with Gadaffi,” Financial Times (London), October 28, 2003 and Stephen Fidler, Mark Huband, and Roula Khalaf, “Return to the Fold,” Financial Times (London), January 27, 2004. 104 In January of 2004, Libya agreed to pay the victims of French UTA DC-10 bombing $170 million. Originally, Libya agreed in 1999 to pay the victims $35 million but the victims’ families demanded more money in the wake of the settlement between Libya and families of the victims of Pan Am 103. See John Lichfield, “Libya to Pay $170 million Over 1989 Attack On French Jet,” The Independent (London), January 10, 2004.

In: White House Studies Compendium, Volume 5 Editor: Robert W. Watson, pp. 143-161

ISBN: 1-60021-542-4 © 2008 Nova Science Publishers, Inc.

COULD YOU SPARE A DIME? BETTER MAKE IT $10,000: CONTRIBUTIONS TO THE CLINTON LEGAL EXPENSE TRUST Israel Waismel-Manor and Shelley Conroy ABSTRACT For all of the concern over the role of money in American politics, President Clinton’s Legal Expense Trust, created to ease the burden of the President’s legal expenses, has not only gone unregulated (its contribution limits and disclosure rules were self imposed) but also uninvestigated. Using original survey data this article seeks to answer three questions. Who are the donors to Clinton's Trust? Why did they make a contribution? And what determines the amount they contributed to the Trust? The final section of the article explores the possible consequences of this loophole and suggests some possible remedies.

INTRODUCTION Long before the public learned about Kenneth Starr and Monica Lewinsky, scholars have warned us of the rise of “politics by other means.”411 In a balkanized political arena, where parties are weak, and the electorate is somewhat indifferent, political actors resort to all means at their disposal, especially the media, the bureaucracy, and the courts to triumph over their opponents. Ever since Watergate, the use of the criminal justice system as a political weapon against one’s opponent has been on the rise. In 1982, there were 158 indictments and 147 convictions of federal officials. By 2001, that number had climbed to 502 and 414 respectively.412 Most Americans have come to accept the fact that federal investigations and civil lawsuits are a part of the political scene.

411

Benjamin Ginsberg and Martin Shefter. Politics By Other Means: Politicians, Prosecutors, and the Press from Watergate to Whitewater, 2nd Ed. (New York: W. W. Norton & Company, 1999). 412 U.S. Department of Justice, Criminal Division, Public Integrity Section. “Report to Congress on the Activities and Operations of the Public Integrity Section for 2001.” Table II. <www.usdoj.gov/criminal/pin/Annual_ Report_2001.pdf> accessed May 21, 2003.

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To ease the burden of these legal expenses many politicians under investigation have recently created defense funds, and asked their supporters to open their hearts and wallets.413 Politicians from Senators Orrin Hatch and Robert Torricelli to House majority Whip Tom DeLay started one, yet no fund has gotten more exposure or money than the Clinton Legal Expense Trust. While there is an extensive literature addressing campaign contributions, little research has been done about these unique donations. For all of the concern over the role of money in American politics, this avenue of potential influence over the president is not only unregulated but also uninvestigated. This paper addresses the latter. In doing so, it analyzes an increasingly important form of political contribution. We start with a descriptive account of Clinton's legal odyssey, from his early days as Arkansas’ Attorney General, to his impeachment trial. In the second section we tell the story of the President’s two Trusts. Using an original survey of contributors to Clinton’s Legal Expense Trust, we attempt to answer, in the third section, who are these donors? Why did they give money to the President? And, what determined the amount they contributed to the Trust? In Politics by Other Means, Benjamin Ginsberg and Martin Shefter lament the price American democracy pays for its recent modus operandi. We, however, lament the price the president and other politicians have to pay, literally, to fight these legal battles. Our concern is not with their finances but with the things desperate politicians may do to battle those bills, and especially with public sentiment towards these contributions. The final section of the paper explores the consequences of this loophole and suggests some possible remedies.

PRESIDENT CLINTON’S LEGAL BATTLES414 President Bill Clinton's legal odyssey goes back to his time as Arkansas’ Attorney General. In 1978, together with his wife Hillary, and business partners James and Susan McDougal, Clinton borrowed $200,000 from Madison Guaranty, a small savings and loan bank, to create the Whitewater Development Corp, a real estate investment. Soon after the Bank collapsed in 1989, following a series of fraudulent loans, accusations of impropriety emerged, naming the Clintons as potential beneficiaries of the illegal activities at Madison. When Vincent Foster, former law partner of Mrs. Clinton and now deputy White House counsel committed suicide in 1993, just a month after he filed delinquent Whitewater corporate tax returns, many observers suspected foul play. In January of 1994 former U.S. attorney Robert B. Fiske Jr. was appointed special counsel to investigate the Clintons' activities in the Whitewater investment. In August, when it was time to renew Fiske's powers, Republicans charged him as being too soft; he was replaced by former U.S. solicitor, Kenneth Starr. Starr’s investigation expanded to other events such as the firing of White House travel office clerks (Travelgate), and the collection 413

Holly Bailey. “The Best Defense: Members of Congress and Personal Legal Funds.” opensecrets.org. July 12, 2001. <www.opensecrets.org/alerts/v6/alertv6_21.asp> accessed May 23, 2003. and Ann Devroy. “Clinton Aides Setting Up Defense Funds to Pay Lawyers’ Bills.” The Washington Post February 29, 1996. A21. 414 The following information chronicles the developments of the Clinton’s legal struggles, and is taken from The Washington Post Online – “Clinton Accused - Special Report". It can be accessed online at <www.washingtonpostonline.com/wp-srv/politics/special/clinton/clinton.htm>

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of hundreds of confidential FBI files on prominent Republicans by a minor White House operative in 1993 and 1994 (Filegate). While Arkansas Gov. Jim Guy Tucker (D) and the McDougals were convicted on charges of conspiracy and fraud415, the President and the First Lady emerged from the investigations relatively unscathed. President Clinton’s legal problems were not limited to the Whitewater scandal. In 1994 Paula Jones filed a civil suit against the President on charges of sexual harassment and assault, three years earlier. Clinton tried to have to have the case dismissed on grounds of presidential immunity416, but the U.S. Supreme Court unanimously dismissed the President's claims that a trial would distract him from performing his work.417 The case went to trial, but a Federal District Judge dismissed it on the grounds that, regardless of the truth of Jones’ accusations, she was not seriously harmed to warrant a claim.418 During the final months of 1997 there had been rumors about a relationship between a young White House intern and the President. These allegations received credibility when Linda Tripp, a friend of the intern Monica Lewinsky, gave Starr tapes of conversations, in which Lewinsky discussed her affair with the President. Starr began to investigate whether Clinton encouraged Lewinsky to lie in the Jones case about the affair. In January 1998, Clinton testified in the Jones case, and denied having sexual a relation with Lewinsky. Even after the story broke on January 21, Clinton continued to deny a “sexual relationship” with the intern, and said that he never asked her to lie. It was not until his August 17 grand jury testimony that Clinton admitted to his intimate contact with Lewinsky, and later said on television that he had an “inappropriate relationship with Miss Lewinsky.”419 A few months later Jones dropped her lawsuit after the President agreed to pay her $850,000, offering no apology or admission. Following Starr's September report to Congress, the Judiciary Committee recommended that the House of Representatives impeach the President for perjury before the grand jury, obstruction of justice, abuse of power, and perjury in the Jones case.420 The House impeached Clinton for perjury before the grand jury and obstruction of justice, but he was later acquitted by the Senate.421 In a Rose Garden statement Clinton told the nation that he was “profoundly sorry” for his actions, and for the “great burden they have imposed on the Congress, and on the American people.”422 The “great burden” his actions imposed on Congress and the American people was one thing. The burden on the President's bank account was another. There is no doubt that Clinton was “profoundly sorry” for that as well.

415

Governor Tucker resigned after the verdict. As for the McDougals, they were both convicted and sentenced to prison. Susan McDougal was sentenced to two years in prison, but began her sentence in May 1998, after spending a year and a half in jail for refusing to testify before Starr’s grand jury and for her obstruction of the investigation. In March of 1998 James McDougal died in prison, a few months before his expected release. 416 For further discussion on presidential immunity and other aspects of Clinton’s legal affairs see Fischer, Louis. “The Law: Legal Disputes in the Clinton Years.” Presidential Studies Quarterly 29 (September 1999) 697-707. 417 Clinton v. Jones 520 U.S. 681 (1997). 418 Jones v. Clinton LR-C-94-290 U.S. District Court Eastern District of Arkansas Western Division (1998). 419 Televised Clinton statement, August 17, 1998. 420 U.S. House of Representatives, Judiciary Committee. House Report 105-830. “Impeachment of William Jefferson Clinton, President of the United States.” December 5, 1998. 421 U.S. House of Representatives. 144 Congressional Record H 11975. 105th Congress, 2nd Session. December 19, 1998.

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A REMEDY FOR LEGAL EXPENSES By mid 1994 the real price of the First Family's legal battles caught up with them. In order to deal with his mounting legal bills, Clinton created an expense fund.

The Presidential Legal Expense Trust With no legal regulation to guide them, Clinton's advisers pitched the idea of creating a fund to pay the cost of Clinton’s legal battles. The concept itself was not new; after Nixon's resignation a fund was established to pay his legal bills, but Clinton's fund was the first set up for a president while in office. The Presidential Legal Expense Trust was established in June 1994 with the following guidelines: contributions must be from U.S. citizens other than federal employees or registered lobbyists; contributions from corporations, labor unions, partnerships, and PACs, or anonymous givers were not accepted; and individuals were limited to $1,000 per contribution in a calendar year.423 At first, the outlook for the President's new fund was positive. Through self-imposed contribution caps, and the selection of prominent citizens for its board of trustees (like Attorney General Nicholas Katzenbach and retired university presidents), the Trust earned the credibility it needed. From a financial perspective, things were also running well. Contributions were coming in at a satisfying pace; the fund received $608,080 in its first six months of operation. Additionally, the President's liability insurance policies helped to pay for the expenses of Jones' sexual harassment case. During 1995, however, the figures began falling short. Contributions to the fund started dropping quite drastically; the first half of 1995 brought in just $258,449, and it diminished to merely $62,000 by the second half of 1996. By 1997, the fund was not only $2.25 million short, but also losing money; its operational bills and fundraising costs exceeded donations. Additionally, the fund triggered a controversy of its own. Judicial Watch, a public watchdog group that deals with ethics and legal issues, brought suit against the Trust, claiming it violated the Federal Advisory Committee Act which mandates public access to groups that advise the president.424 In February of 1996, a District of Columbia Circuit Court of Appeals ruled that the Trust did not provide policy advice and, as such, was not in violation of the Act. The Court’s decision also confirmed a prior ruling of the Office of Government Ethics, which had previously given the President a green light to create the Trust.425 Additionally, the Justice Department launched an investigation into the possibility that hundreds of contributions were given in the hopes of buying access to the White House. A Senate investigation that followed was unable to answer whether or not such contributions were linked in any way to the favors received by donors.426 But the investigation and its 422

Peter Baker and Helen Dewar. "The Senate Acquits President Clinton," The Washington Post. February 13, 1999. 423 Presidential Legal Expense Trust. Bi-annual Report of the Trust. February 22, 1996. (Ex. 2). 424 Locy, Toni. “Group Sues for Access to Clinton Legal Fund,” The Washington Post. August 5, 1994. A18. 425 Judicial Watch, Inc. v. Clinton. 76 F.3d 1232 (D.C. Cir. 1996). 426 U.S. Senate. Report 105-167, Part 2. “Investigation of Illegal or Improper Activities in Connection with the 1996 Federal Election Campaigns.” Committee on Governmental Affairs, 1998.

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negative public exposure had an immediate impact on the cash flow: potential donors were increasingly reluctant to contribute. The Trust’s failure was also embedded in its own guidelines. The self-imposed $1,000 limit was too low. Many of the President's supporters were willing to give more money. Also, because the Clintons themselves were the Trust’s grantors, or founders, it was not free to solicit contributions or take advantage of all possible ways of contacting potential donors. By February 1997, the President was said to be "painfully aware" of the Trust’s poor performance and of his mounting legal bills.427

The Clinton Legal Expense Trust Within a year, Clinton and his advisers decided to terminate the original trust and create a new one. On February 17, 1998, the Clinton Legal Expense Trust was established by former US Senator David H. Pryor of Arkansas. Its official purpose was “to enable Americans to help defray the burdensome legal expenses that are being incurred by the President and the First Lady.”428 By this time, these bills amounted to approximately $3 million, far more than the President could afford to pay. Headed by Terry McAuliffe, successful Democratic fundraiser and key player in the Clinton-Gore 1996 presidential campaign, the new Trust kept most of the guidelines that directed contributions to the earlier Trust, including its commitment to biannual disclosure. Two major changes, however, were made. Because Pryor was the Trust’s grantor, it was now allowed to seek out donations on the Clinton’s behalf through direct fundraising, as long as the request was not directly from Clinton. Also, with no regulatory agency like the FEC to cap contributions, the self-imposed limit was raised to $10,000 per year. This new limit was by no means arbitrary since the IRS imposes a federal gift tax on any gift beyond $10,000.429 The change was remarkable. In its first six months the Trust received almost three times the money that the previous fund had earned in over three years, totaling $2.2 million. On the one hand, the increase had to do with the inner changes in its rules and charter. On the other, the political turmoil that had many people questioning the integrity and motives of the special council's investigation also led to an increase in donations. Though it had a devastating outcome for the President, the breaking of the scandal actually helped the Trust in several ways. First, the President's legal battles, once thought to be private, were now seen by Democrats as an orchestrated Republican witch-hunt; this mobilized supporters to come to his defense. Many Democrats and non-Democrats sympathetic to the President, or to the institution of the presidency, became convinced that the investigation was out of line because it extended into the realm of private behavior. Second, others, though indifferent to the investigation itself, worried that economic prosperity would end with Clinton’s impeachment. Lastly, the scandal gave substantial visibility to the President’s legal problems and expenses. 427

John F. Harris. “Clinton Defense Fund Returns More Than it Raises,” The Washington Post. February 28, 1997, A6. 428 Clinton Legal Expense Trust. “The Clinton Legal Expense Trust.” Clinton Legal Expense Trust 1998 brochure to potential contributors. <www.clintontrust.com/brochure.html> accessed 1/4/00. 429 Since 1999, this limit has been indexed for inflation and is currently $11,000 (Department of the Treasury. Internal Revenue Service. Publication 950, “Introduction to Estate and Gift Taxes).

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The fundraising accomplishments of the Trust itself earned positive publicity which generated even more support. Coverage was also generated by Hollywood’s relationship to the President and the Trust. Support from famous directors, producers and performers like Tom Hanks and Ron Howard became a news story of its own. Together with a direct-mail solicitation campaign sent to about 170,000 potential supporters drawn from the 1996 Clinton-Gore, and other Democratic fundraising list, this publicity gave the Trust all that it needed to succeed. To summarize, from Feb 17, 1998 through December 31, 2000; 113,775 donors contributed $8,503,169. In reality the number of donors is much smaller. First, many names repeat themselves, meaning donors gave more than once. The 204 donations of $10,000 came from 147 individuals who actually come from 127 households; there were many cases in which a spouse was an additional contribution channel. Though the Trust portrayed the donors as ordinary individuals, pointing out that 95 percent of the contributions have come in amounts less than $100, it is important to remember that the 204 $10,000 contributions amounted to almost one - quarter of the total contributions!

THE SURVEY During July 1999, 200 individuals from the 38,560 donors who had contributed to the Trust between February 17, 1998 (the day the Trust was created) and December 31, 1998 (the Trust’s second public report release) were randomly selected and surveyed. While the sample size is rather small (N=200), they represent the most interesting, and probably the most important contributors to the Trust. The reason lies in the fact that these individuals made their contributions during the scandal, and prior to the President’s acquittal, and yet were surveyed shortly after. Unlike those who may have joined the bandwagon and made a donation after the impeachment trial was over430, our survey captures Clinton’s most loyal group, and does so at a time when they still recall their motivations for giving. The following sections will explore three important questions: Who are these donors? What are the reasons they gave to the Legal Expense Trust? And finally, what determines the level of the contributions?

Who are the Donors? In order to explain who the donors are, we look at two types of characteristics: demographic and political. We see in Table 1 that African Americans and Hispanics are underrepresented in the survey. Only 6.6 percent of the contributors are African Americans,

430

Donations continued to flow to the Fund after the survey was conducted, with many contributing after Clinton’s acquittal; these donors are not represented in our survey. While this group is close to half of the entire population of contributors, these donors may have different reasons for making a donation, and they may also share other important characteristics not found in the data presented here. Thus, our sample should not be seen as representative of the entire donor population.

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while their percentage in the general population at the time was 13 percent.431 Hispanics also contribute less than their percentage in the population: 7.1 percent and 11.7 respectively.432 When it comes to religion, there is also under and overrepresentation. Protestants contribute less than their relative size in the population, about ten percent less than the 55 percent they hold in the general population. The Catholics’ share, on the other hand, is somewhat higher: 40.9 percent in contrast to their 28 percent in the population. And, while Jews are over represented in the donor pool, making up 12.2 of the donors, close to six times their size in the population, Muslims are almost nonexistent; only one Muslim contributed to the Trust.433 Contributors in general are highly educated. Thirty five percent had a Masters degree or higher, 38 percent are college graduates, 16 percent had attended college for a few years, and only 13 percent were not educated beyond high school (N=191). Additionally, the donors’ occupations are mainly high training and prestige positions.434 Ninety three of the respondents are retired, and an additional 16 donors were either homemakers or housewives (N=198). Why are so many contributors retired? It might be, as Brown, et al. suggests, that older people respond better to printed material than the more technologically sophisticated younger generations, or that “older people enjoy getting and reading mail, have more time to absorb the message, and have more disposable income to give to candidates.”435 To some extent, this could be also the case for housewives/homemakers. Finally, donor family income is also high. This should come as no surprise. We find a high level of correlation between education and job level training (r=0.30, p=0.000) and education and income (r=0.35, p=0.000). While the national income average at that time was $39,657 (U.S. Census Bureau, 2000), the data here shows that for Clinton's contributors the number is much higher with 64.5 percent earning over $49,999. It is important to note that our respondents are probably less affluent than all Trust donors are as a whole, as we find in our comparison of the two mean contributions: $49.45 for the survey and $96.25 for the entire Trust donor population. Our data here coincides with Frank Sorauf's (1992) findings that political donors have higher levels of education, occupational prestige, and income than other Americans.436 Besides contributing to the President's Trust, many donors have also participated in other political activities. The most common one was voting; 192 out of 194 individuals voted in the last four years. This was followed by 76 who contacted an official or a representative, and 44 that volunteered for a campaign. Twenty five respondents protested, marched or demonstrated during the same time period.

431

Jesse McKinnon and Karen Humes. “The Black Population in the United States.” Washington D.C: U.S. Census Bureau, 2000. 432 Roberto R. Ramirez. “The Hispanic Population in the United States.” Washington D.C: U.S. Census Bureau, 2000. 433 U.S. Census Bureau. “Population.” Statistical Abstracts of the United States. issued February 2001. At Table 75. 434 The categories are an adaptation to the ones used in Voice and Equality, 293 (their first and second categories were merged here into one). Examples of these levels include : very low training - dishwasher, cashier, mail carrier, machine operator. Low training - electrician, constructor inspector. High training - insurance agent, teacher, engineer. Very high training - physician, attorney. 435 Clifford W. Brown, Jr., Lynda Powell, and Clyde Wilcox. Serious Money: Fundraising and Contributing in Presidential Nomination Campaigns (Cambridge: Cambridge University Press, 1995), 55. 436 Frank J. Sorauf. Inside Campaign Finance (New Haven: Yale University Press, 1992), 35.

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We would expect that those individuals contributing to the Trust would be Democratic Party supporters. Approximately 58 percent of our sample voted for Dukakis in the 1988 presidential election, 79.2 percent voted for Clinton in 1992, and 97.4 percent supported him in 1996. The 1996 data clearly confirms that most respondents supported Clinton prior to the scandal. Do these numbers reflect an affinity to the President or an affinity to the Democratic Party? The answer may be both. The data indicates that a majority of our sample are relatively strong Democrats. Almost 77 percent of our sample group identify themselves as strong or not very strong Democrats, with an additional nine percent leaned Democratic. Only three people in the entire sample were Republican or leaned Republican.

Why Did They Make a Contribution? Political participation can be defined as an “activity that has the intent or effect of influencing government action, either directly by affecting the making or implementation of public policy, or indirectly by influencing the selection of people who make those policies.”437 These activities may take many forms, such as voting, working as a volunteer, protesting, marching, writing letters to congressmen, and contributing money. Over the last decades, political contributions have become the third largest form of political participation (behind voting and contacting officials), rising from 13 percent in 1967 to 23 percent in 1987. Why are people so willing to donate money to political causes? Herbert Alexander describes an array of reasons: 1) solicitation; 2) out of a sense of civic duty or attachment to a cause; 3) personal identification with a candidate, group, or party; 4) concern for government policy; 5) access to government officials; and 6) ego or self-esteem.438 Usually it will be a mixture of goals that motivates a person to contribute.

437

Sidney Verba, Key Lehman Schlozman, and Henry E. Brady. Voice and Equality: Civic Voluntarism in American Politics (Cambridge: Harvard University Press, 1995), 38. 438 Herbert E. Alexander. Financing Politics: Money, Elections and Political Reform (Washington D.C: Congressional Quarterly Press, 1976), 49-50; see also Brown et al, 51.

Table 1. Demographic Characteristics of Contributors Variable Race Religion Education Occupation Income

Total White 156 (85.2%) Protestant 82 (45.3%) High School 24 (12.6%) Homemaker 16 (8.1%) $25,000-49,999 66 (34.7%)

Black 12 (6.6%) Catholic 74 (40.9%) Some College 31 (16.2%) Very Low Training 6 (3.0%) $50,000-99,999 111 (58.4%)

Hispanic 13 (7.1%) Jewish Muslim 22 (12.2%) 1 (0.6%) College Grad Masters or Above 72 (37.7%) 64 (33.5%) Low Training High Training 25 (12.6%) 27 (13.6%) $100,000-249,999 12 (6.3%)

Asian 2 (1.1%) None 2 (1.1%)

183 181 191

Very High Training Retired 31 (15.7%) 93 (47.0%) $250,000 and over 1 (0.5%)

198 190

Table 2. Political Characteristics of Contributors Variable Voted* Contacted Official or Representative* Volunteered for a Campaign* Protested, Marched, or Demonstrated* Voted for Democratic Candidate Partisan * In the last four years

Total Yes 192 (99%) Yes 76 (39.2%) Yes 44 (22.7%) Yes 25 (12.9%) 1988 111 (57.8%) Strong Democrat Democrat 95 (49.2%) 53 (27.5%)

No 2 (1%) No 118 (60.8%) No 150 (77.3%) No 169 (87.1%)

Leaner Democrat 18 (9.3%)

1992 152 (79.2%) Independent 24 (12.4%)

Leaner Republican 2 (1%)

1996 186 (97.4%) Republican Strong Republican 1 (0.5%) -

194 194 194 194 192

193

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It is important to understand the difference between contributions and other political resources. First, requests to contribute are the most common type of political solicitation and are more likely to come from strangers, especially through the mail. Second, unlike other forms of activism, contributors do not tend to think that their activity made much difference.439 Third, contributors also have a lower sense of gratification from taking part in this activity than those who volunteer, demonstrate or vote.440 The use of money as a political resource carries with it important consequences for political participation. Money separates the haves from the have-nots, and gives an advantage to those who have money to spend.441 While other types of participation, like voting, give all the same amount of influence, contributions do not. Also, fewer people participate by donating money. Why is this the case? Sorauf writes that while some contributors respond to inner motivations and political cognitions, like strong political convictions, “they respond more immediately to a specific stimulus,” i.e., a solicitation.442 So, why are not all people solicited? The reason lies in the practical aspects of fund raising. Predictably, the wealthier a person is likelier than a poor individual to donate money. Moreover, since the most likely person to make a contribution is one who contributed before, fund raisers rely heavily on previous donor mailing lists.443 While there is always some attempt to attract contributions from new prospects, fund raisers rely heavily on these lists.444 Using the 1996 Clinton-Gore contributors’ list, the Trust sent approximately 170,000 letters during its first six months of activity, generating about a ten percent response rate.445 In our sample, 121 said they were solicited, 51 said they acted on their own initiative, and 20 responded that a friend asked them to contribute (N=192). What explains this behavior? For contributors who were not solicited, and even those who were, there may be other reasons for making a contribution to the Trust. One reason may be that these individuals like to contribute money to political causes. Nearly 56 percent had in fact made a previous donation. Additionally, these individuals may have a tendency for political participation in general. Their contribution to the Trust may be just one aspect of their broader political activity. To evaluate the connection between the level of activism and donations, the number of the different activities our contributors took part in during the last four years were recoded to create a variable called “activism.”446 Only two contributors did not take part in any one of the activities below (vote, contact, protest, volunteer, and contribute). 439

Verba et al, 517. All these may help to explain why contributions have risen significantly in the last two decades. Although much of the literature focuses on the high costs of campaigns as the major reason for higher volume and number of contributions, there is hardly any discussion on the higher donation sums contributors need to give these days in order to feel that their donation made a difference. 441 For most types of contributions, there is an upper limit to the amount a donor can give. This equalizes the rich donors with the very rich ones, but, for most people, this cap is already beyond their financial means. 442 Sorauf, 35. 443 When dealing with computer generated mailing lists errors are bound to happen. Bernard Lewinsky, Monica's father received a letter from President Clinton's Legal Expense Fund asking him for a donation. "Lewinsky, a Los Angeles physician, marked the letter "return to sender" and added a note: "You must be morons to send me this letter". See Steve Harley. "Mr. President, Are You Totally Crazy?" Los Angeles Times, September 1, 1999. 444 Brown et al, 33. 445 Clinton Legal Expense Trust press release. “Over $2.2 Million Raised by Clinton Legal Expense Trust in Six Months.” The Clinton Legal Expense Trust press release, August 21, 1998. 446 The variable “activism” is measured on a scale of 0-5. It measures the number of the following activities in which an individual has participated: voting; protesting, marching, or demonstrating; contacting a government 440

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Table 3. Prior political activism Variable

Total 0

1

2

3

4

5

2 (1%)

66 (34.2%)

55 (28.5%)

35 (18.1%)

12 (6.2%)

23 (11.9%)

193 Activism

Since our sample consists of individuals who have made a contribution to Clinton’s Trust, we would expect that they are more actively involved in politics than the average citizen. The data confirms that they are a politically active group, especially when compared to the general public. Sidney Verba, et al’s findings show that, in an election year, 71 percent of the people in their survey voted, 34 percent contacted an official, eight percent worked for a campaign, six percent protested, and 24 percent made a political contribution.447 Our analysis, as described above, finds that 99 percent, 39.2 percent, 22.7 percent, 12.9 percent, and 55.9 percent participated in these activities, respectively.448 The survey included an open-ended question that asked donors for their reasons for contributing. The responses were grouped into the following categories, included in Table 4.449 Many of the responses fell into the category that Clinton was a good man (20.7 percent). The second highest response dealt with Clinton’s performance as president, and his policy and political success (19.2 percent). The third highest reason for contribution was that Clinton was unjustly attacked (18.7 percent). The motivations expressed here correspond with the results of many public opinion polls taken during the same summer our survey was conducted. In a late July poll taken for NBC News and the Wall Street Journal, 73 percent of those surveyed approved of the way President Clinton was handling the economy.450 Around the same time, Clinton had a 64 percent overall approval rating.451 Corresponding with the above responses, in early August, 65 percent of those polled considered the scandal involving Lewinsky a “private, personal matter.”452 Even the hostility towards Republicans corresponds with public sentiments; a quarter of those polled thought the exposure of the Clinton-Lewinsky affair was the result of a right-wing conspiracy.453

official or representative; volunteering for a campaign; (all four in the last four years); or contributing money to politicians (ever). 447 Verba et al, 51. 448 The 55.9 percent denotes the portion of the sample that made a political contribution prior to their donation to the Clinton Legal Expense Fund. It is important to note that Verba’s survey asked respondents if they had participated in these activities in the past year, while ours asks about the past four years. Nevertheless, Verba’s survey took place in an election year, when all forms of political participation are higher, so we do not expect a drastic difference between our two measurements. 449 Because some respondents provided more than one answer, we took the first one to be the most important and coded it as that person’s motivation. 450 NBC News/Wall Street Journal Poll. (July 24-26, 1999). Roper Center at University of Connecticut, Public Opinion Online. 451 Fox News/Opinion Dynamics Poll. (July 28-29, 1999). Roper Center at University of Connecticut, Public Opinion Online. 452 CBS News Poll. (August 1-3, 1999). Roper Center at University of Connecticut, Public Opinion Online. 453 Zogby Real American Poll. (October 11-14, 1998). Roper Center at University of Connecticut, Public Opinion Online.

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Israel Waismel – Manor and Shelley Conroy Table 4. Self - reported reasons for contribution

Reason Clinton is a good man Clinton does a good job Clinton was unjustly attacked I want to help support Clinton Personal life should be private I am against the Republicans I want to be involved Other Total

Frequency 41 (20.7%) 38 (19.2%) 37 (18.7%) 31 (15.7%) 20 (10.1%) 14 (7.1%) 10 (5.1%) 7 (3.5%) 198 (100%)

What Explains the Contribution Level? Thus far we have presented data on the contributors that explains both who they are and why they gave money to Clinton’s Trust. Within our sample, however, and within the entire donor population, there is substantial variation in the levels of contributions. Using multivariate regression analysis, six potentially influential variables are tested to explore the determinants of contribution size. First, we present the theoretical arguments and expectations for these six variables. We then present the regression results and analyze the explanatory power of these variables. To begin, we expect that those individuals who were solicited for a contribution will give more money than those who were not. At first, this claim may seem counterintuitive; one might expect that those who will contribute the most money are those who will make a donation without being asked to do so. However, the individuals who were contacted by the Clinton Legal Expense Trust were compiled from a list of donors who had made a political contribution in the past. Thus, we would expect that these individuals who had contributed before, and demonstrated a willingness to make financial donations, would give higher amounts of money. Secondly, we would expect self-identified Democrats to donate more than Independents or Republicans. In our analysis, we measure partisanship on a scale of one to seven; a lower score indicates strong Democrat. Since we expect Democrats to give more money, the coefficient should be negative. Our second variable measures the voting history of each donor. This variable can take on a value of zero, one, or two, and represents the number of times an individual voted for Clinton in the 1992 and 1996 presidential elections. One can assume that the higher this number is, the stronger the respondent’s support for Clinton. Education and income are two variables that are often strongly related to each other. Consequently, we have very similar expectations for their influence in our analysis. As a respondent’s income increases, we expect that their donation will be larger as well. Since high levels of education typically correlate with higher income, education and level of donation should also be positively related.

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Table 5. Expectations of Variable Influence Independent Variables Solicit Partisanship Voting History Education Income Activism

Expectation + + + + +/-

One might also expect that occupation would be closely related to the level of contribution. In our sample, there is a statistically significant correlation between occupation and income (r=0.43, p=0.000). To include both in the regression model would create problems of multicollinearity, since occupation is really a proxy for income. Thus, we chose not to incorporate occupation into our final analysis. Some may argue that the inclusion of both education and income would present similar problems. While this may be true, we have theoretical reasons for keeping education in the model. Past studies have demonstrated that high levels of education are also associated with a liberal ideology.454 Because this trait may influence contribution levels, we felt it was necessary to keep education in the model despite its correlation with income. Finally, what are our expectations for activism? Should we expect that individuals who have high levels of political participation will also donate more money? At first glance, one would expect a positive relationship. High levels of political participation, including prior contributions, would indicate a higher level of money when a contribution is made. However, previous research indicates that this may not be the case. According to Verba et al, “time and money function differently as inputs for political activity…the affluent are more likely than the poor to become active. Once active, however, the poor are as generous with their time as those who are better off financially…No such leveling occurs when it comes to money.”455 This leads us to believe that those who are more active in giving their time (for voting, protesting, volunteering) may not have extra money to give away. Thus, we have no clear expectations for the relationship between donation and activism levels. Table 6 provides the results of a regression analysis that seeks to explain the level of donations for the individuals in the sample. Two variables in the model demonstrate statistical significance: income (p = 0.000) and voting history (p = 0.025). As an individual moves up one income bracket, their contribution increases by about $40. The measurement of this particular variable is less than ideal, and will be addressed later in the paper. But the conclusion makes sense: those who have more money are likely to give more money. The coefficient for voting history is very surprising: it is negative. The more times an individual has voted for Clinton, the lower their contribution is, by about $25. None of the other independent variables are statistically significant.

454

Mary R. Jackman and Michael J. Muha. “Education and Intergroup Attitudes: Moral Enlightenment, Superficial Democratic Commitment, or Ideological Refinement?” American Sociological Review. 49:6 (December 1984) 751-769. 455 Verba et al, 192.

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Israel Waismel – Manor and Shelley Conroy Table 6. OLS Regression Results on Level of Donation to Legal Expense Trust456

Variable Solicit Partisanship Voting History Education Income Occupation Activism Constant Adjusted R2

Regression Coefficient (Standard Error) 8.51 (8.06) -6.81 (4.43) -24.75** (11.20) -1.51 (3.13) 30.54*** (6.91) -1.76 (2.54) -2.83 (2.90) 14.62 (32.67) 0.168

N=193 *p