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The “Problem of Preferences”: Medicare and Business Support for the Welfare State*

  • David E. Broockman (a1)

Abstract

Few political observers would readily assume that a present-day politician's or interest group's claims about their preferences accurately reflect their genuine views. However, scholars often unwittingly make this very assumption when inferring the preferences of historical political actors. In this article I explore the influence of business groups on Medicare's passage to illustrate how inattention to political actors’ strategic misrepresentations can bias qualitative and quantitative research. An ongoing debate wrestles with the pattern that businesses often grant support to welfare-state expansions just before they occur, a regularity some take as evidence that business interests dictate these expansions. I use Medicare as a case study and document that key business groups and their allies did not truly favor the program. However, I also show that these actors strategically misrepresented their preferences as Medicare's passage became likely in order to advance more limited alternatives. The strategic nature of this position is exceptionally easy to miss; yet inattention to it produces the opposite, erroneous conclusion about these actors’ historical role. Medicare's legislative history thus illustrates the methodological necessity of documenting whether political actors are misrepresenting their preferences. I discuss how scholars can do so by tracing actors’ stated preferences across strategic circumstances, including audiences and time.

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*

I thank Sam DeCanio, Jacob Hacker, Sigrun Kahl, Theodore Marmor, David Mayhew, Thomas Paster, Eric Schickler, and seminar participants at Berkeley for their helpful feedback on this project. Any remaining errors are, of course, my own. Special thanks are due to the tremendously helpful and generous archival research staffs at the LBJ Presidential Library in Austin, Texas; National Archives in Washington, DC; the University of Virginia Miller Center of Public Affairs' Presidential Recordings Program, Bailey Library at Hendrix College in Conway, Arkansas; Wisconsin Historical Society in Green Bay, Wisconsin; Hagley Library in Wilmington, Delaware; Yale University Sterling Memorial Library; and Columbia University Butler Library. This research was funded in part by two Mellon grants from Yale University. I also thank the Beswick family, Mac Barnes, and Danae Steele for their hospitality. I finally acknowledge the National Science Foundation Graduate Research Fellowship Program for support.

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1. Guest List for the Signing of the Medicare Bill, 29 July 1965, Ex LE/IS, Box 75, LBJ Library.

2. M. E. Feary to John Byrnes,. 22 February 1965, Box 29, John Byrnes Papers, Wisconsin Historical Society.

3. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Leslie J. Dikovics, 89th Cong., 1st sess., 10–19 May 1965.

4. See Swenson, Peter A., Capitalists Against Markets (Oxford: Oxford University Press, 2002); Mares, Isabela, The Politics of Social Risk: Business and Welfare State Development (Cambridge: Cambridge University Press, 2003). See next section for review.

5. See Smith, Mark A., American Business and Political Power: Public Opinion, Elections, and Democracy (Chicago: Chicago University Press, 2000); Martin, Cathie Jo, Stuck in Neutral: Business and the Politics of Human Capital Investment Policy (Princeton, NJ: Princeton University Press, 1999).

6. See Gerring, John, Case Study Research: Principles and Practices (Cambridge: Cambridge University Press, 2007), chap. 7.

7. See Jacobs, Lawrence R., The Health of Nations (Ithaca, NY: Cornell University Press, 1993), 157–62, 203–6; Oberlander, Jonathan, The Political Life of Medicare (Chicago: University of Chicago Press, 2003).

8. Hacker, Jacob S. and Pierson, Paul, “Business Power and Social Policy: Employers and the Formation of the American Welfare State,” Politics and Society 30 (2002): 277325.

9. Korpi, Walter, The Working Class in Welfare Capitalism. (London: Routledge, 1978), 317.

10. Korpi, Walter, The Democratic Class Struggles (London: Routledge, 1983), 21.

11. Swenson, Peter A.. “Varieties of Capitalist Interests: Power, Institutions, and the Regulatory Welfare State in the United States and Sweden,” Studies in American Political Development 18 (2004): 129; Swenson, Capitalists Against Markets, 5; Swenson, Peter A., “Bringing Capital Back in, or, Social Democracy Reconsidered: Employer Power, Cross-Class Alliances, and Centralization of Industrial Relations in Denmark and Sweden,” World Politics 43 (1991): 513–44.

12. Gordon, Colin, New Deals: Business, Labor, and Politics in America: 1920–1935 (Cambridge: Cambridge University Press, 1994), 4, 241–42.

13. Mares, Politics of Social Risk, 5, 9, 264.

14. Swenson, Peter A., “Yes, and Comparative Analysis Too: Rejoinder to Hacker and Pierson,” Studies in American Political Development 18 (2004): 196200. See also Swenson, Peter, “Arranged Alliance: Business Interests in the New Deal,” Politics and Society 25 (1997): 66116; Swenson, “Bringing Capital Back In”; Gordon, New Deals; Martin, Cathie Jo and Swank, Duane, “Does the Organization of Capital Matter? Employers and Active Labor Market Policy at the National and Firm Levels,” American Political Science Review 98 (2004), 593611; Berkowitz, Edward D. and McQuaid, Kim, Creating the Welfare State: The Political Economy of Twentieth Century Reform (New York: Praeger, 1988); Jenkins, J. Craig and Brents, Barbara G., “Social Protest, Hegemonic Competition, and Social Reform: A Political Struggle Interpretation of the Origins of the American Welfare State,” American Sociological Review 54 (1989): 891909. To some extent also see Iversen, Torben and Soskice, David, “An Asset Theory of Social Policy Preferences,” American Political Science Review 95 (2001): 875–93; Domhoff, G. William, The Power Elite and the State: How Policy Is Made in America (New York: Aldine de Gruyter, 1990), chap. 4; Quadagno, Jill S., The Transformation of Old Age Security (Chicago: University of Chicago Press, 1988). For a general review of the business-interest literature, see also pages 177–81 in Korpi, Walter, “Power Resources and Employer-Centered Approaches in Explanations of Welfare States and Varieties of Capitalism: Protagonists, Contesters, and Antagonists,” World Politics 58 (2006): 167206.

15. Hacker and Pierson, “Business Power and Social Policy”; Korpi, “Power Resources and Employer-Centered Approaches.”

16. Swenson, “Varieties of Capitalist Interests.”

17. Frieden, Jeffry A., “Actors and Preferences in International Relations,” in Strategic Choice and International Relations, ed. Lake, David A. and Powell, Robert (Princeton, NJ: Princeton University Press, 1999). For a more formal discussion of why political actors can be expected to behave insincerely a great deal of the time, see Penn, Elizabeth M., Patty, John W., and Gailmard, Sean, “Manipulation and Single-Peakedness: A General Result,” American Journal of Political Science 55 (2011): 436–49.

18. See David Kirkpatrick, “White House Affirms Deal on Drug Cost,” New York Times, August 6, 2009, A1.

19. See Hacker and Pierson, “Business Power and Social Policy.”.

20. See Cox, Gary and Magar, Eric, “How Much Is Majority Status in the U.S. Congress Worth?American Political Science Review 93 (1999): 299309.

21. See especially Pierson, Paul, “When Effect Becomes Cause: Policy Feedback and Political Change,” World Politics 45 (1993): 595628.

22. Swenson, “Yes, and Comparative Analysis Too.”

23. A final category, “Audience Effects,” might encapsulate reasons that political actors misrepresent their preferences to placate accountability agents who are monitoring their behavior, such as voters or interest-group members. Political scientists well understand such phenomena to exist, however, and the dynamics discussed here focus on instances where even a purely policy-motivated, unitary actor would still choose to misrepresent their preferences.

24. See Oberlander, The Political Life of Medicare, 22–25.

25. Marmor, Theodore R., The Politics of Medicare (London: Routledge, 1973), 13.

26. Marmor, The Politics of Medicare, 24–30.

27. Ibid., 24–27.

28. Blumenthal, David, The Heart of Power (Berkeley: University of California Press, 2009), 143–44.; Kooijman, Jaap, . . . And the Pursuit of National Health (Amsterdam: Rodopi, 1999).

29. Sundquist, James L., Politics and Policy: The Eisenhower, Kennedy, and Johnson Years (Washington, DC: Brookings, 1968), 308.

30. Blumenthal, The Heart of Power, 139, 146, 207–12.

31. Kooijman, And the Pursuit of National Health, 145–46; Marmor, The Politics of Medicare, 24–27.

32. Kooijman, And the Pursuit of National Health, 149–59.

33. Blumenthal, Heart of Power, 179; Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 3 June 1964, Citation #3642, Recordings of Telephone Conversations—White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

34. Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 6 June 1964, Citation #3686, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

35. White House legislative aide Lawrence O'Brien would later say,

When Wilbur Mills ultimately supports you, he has done it on two counts. One, he has finally decided that he's in a reasonably comfortable position to be helpful, and two, that he has every assurance in his own mind that it will succeed. You've got to remember that Wilbur Mills’ opposition to Medicare and substitution to Kerr-Mills to a great extent had to do with Wilbur Mills’ great ability to count heads. He wasn't going to take on a crusade that was doomed to failure.

Also,

Wilbur Mills was conservative in his approach to legislation. He was one fellow who, in my dealings with him, wanted to be fully assured that a bill, once it reached the floor, would pass. The last thing Wilbur Mills would allow to happen is to bring something to the floor that would be defeated. Secondly, he always wanted to be in a position to have a closed rule when it came to the floor so it could not be decimated by amendment. Once he was in that position, you could be very comfortable about the end result. So two things had to happen: one, Wilbur Mills have a change of view regarding the concept of Medicare; and two—as important if not more so—full and total assurance that it would pass.

Transcript, Lawrence F. O'Brien. Oral History Interview XI, 24 July 1986, by Michael L. Gillette, Internet Copy, LBJ Library, (emphasis mine); O'Brien similarly wrote to the president in January 1964 that Mills had “great interest in fashioning a bill that [would] pass” (emphasis mine, Lawrence F. O'Brien to Lyndon B. Johnson, 27 January 1964, Ex LE/IS, box 75, LBJ Library); see also Transcript, Wilbur Mills Oral History Interview II, 25 March 1987, by Michael L. Gillette, Internet Copy, LBJ Library for Mills’ own consistent take. This is also consistent with other scholarship on the period, which indicates that Mills would not allow bills to move forward unless he was certain they would pass. See Fenno, Richard, Congressmen in Committees (Boston: Little Brown and Company, 1973), 5455, 203; Manley, John, The Politics of Finance (Boston: Little Brown and Company, 1970), 106; Zelizer, Julian, Taxing America: Wilbur D. Mills, Congress, and the State, 1945-1975 (Cambridge: Cambridge University Press, 1998).

36. Marmor, The Politics of Medicare, 56; Kooijman, . . . And the Pursuit of National Health, 159–62. For a more detailed account of this period, see Christy Chapin, “Ensuring America's Health: Publicly Constructing the Private Health Insurance Industry,” ch. 8, (PhD dissertation, University of Virginia, 2011).

37. Sundquist, Politics and Policy, 317.

38. Marmor, The Politics of Medicare, 57-59.

39. Harris, A Sacred Trust, 177.

40. Mike Manatos to Lawrence F. O'Brien, 8 December1964, Ex LE/IS, Box 75, LBJ Library.

41. Harris, A Sacred Trust, 174.

42. Lawrence Grossback, Peterson, David, and Stimson, James, Mandate Politics (Cambridge: Cambridge University Press, 2006), 12, 27, 45.

43. Marmor, The Politics of Medicare, 57–59; Blumenthal, The Heart of Power, 185; Kooijman, . . . And the Pursuit of National Health, 164. The 1964 ANES illustrates the point: Medicare enjoyed public support by a greater than 2 to 1 margin. American National Election Studies (Ann Arbor: University of Michigan, Center for Political Studies, 1964).

44. Marmor, The Politics of Medicare, 60–61; Recording of Conversation between Lyndon B. Johnson and Walter Reuther, 29 November 1964, Citation #6474, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

45. Transcript, Wilbur Mills Oral History Interview II, 25 March 1987, by Michael L. Gillette, Internet Copy, LBJ Library, (emphasis mine).

46. Harris, A Sacred Trust, 179.

47. Kooijman, And the Pursuit of National Health, 164–65; Transcript, Lawrence F. O'Brien Oral History Interview XI, 24 July, 1986, by Michael L. Gillette, Internet Copy, LBJ Library; Wilbur J. Cohen to Jack Valenti, 4 March 1965, Ex LE/IS, Box 75, LBJ Library.

48. Kooijman, And the Pursuit of National Health, 164–65; Marmor, The Politics of Medicare, 61; David, Sheri I., With Dignity (Westport, CT: Greenwood Press, 1985), 126; Harris, A Sacred Trust, 180.

49. Reminiscences of John Byrnes, 1967, Butler Library Oral History Collection, Columbia University, (emphasis mine).

50. David, With Dignity, 126; Kooijman, And the Pursuit of National Health, 165.

51. Marmor, The Politics of Medicare, 64.

52. Kooijman, And the Pursuit of National Health, 166–68; Marmor, The Politics of Medicare, 64; David, With Dignity, 129; Blumenthal, The Heart of Power, 188–89.

53. U.S. Congress House Committee on Ways and Means, Executive Session on Medical Care for the Aged, 89th Cong, 1st sess., 2 March 1965.

54. Vogel, David, Fluctuating Fortunes: The Political Power of Business in America (New York: Basic Books, 1989).

55. Zelizer, Taxing America.

56. Box 49, National Association of Manufacturers (NAM) Papers, Hagley Museum and Library.

57. Medical Care for the Aged Information Kit, January 1960, Box 23, NAM Papers, Hagley.

58. Flyer Against the Forand Bill, 1959?, Box 23, NAM Papers, Hagley.

59. Medical Care Under Social Security, November 1961, Box 132, NAM Papers, Hagley.

60. Industry's Viewpoint on Medical Care, May 1962, Imprints Collection, Hagley.

61. Speech by James E. Higgins at Columbia University, 12 June 1962, Box 23, NAM Papers, Hagley.

62. “Medical Care, Voluntary or Mandatory?,” NAM Employee Health and Benefits Committee, 1963, Box 132, NAM Papers, Hagley.

63. NAM Bulletin, 7 May 1962, Box 49, NAM Papers, Hagley.

64. NAM Memo to Members, 11 September 1964, Box 49, NAM Papers, Hagley.

65. NAM Washington Reports, 18 September 1964, NAM Papers, Hagley. The NAM also asked its members to exert particular pressure on Wilbur Mills and the members of the House Ways and Means Committee, especially in the wake of what the NAM termed the “baptism of pressure” these key politicians were reporting from “elderly-voter groups and organized labor” (NAM Bulletin, March 1962, Box 23, NAM Papers, Hagley). Indeed, even as the Medicare bill lost ground after its 1962 defeat, the NAM told members that it “behooves the opposition to remain informed and active in the interim” because Kennedy and organized liberal groups would continue to raise the issue (NAM Bulletin, July 1962, Box 23, NAM Papers, Hagley). Throughout 1962 and into 1963, a call to action opposing Medicare continued to command headlines in the NAM's weekly legislative updates to its members (see Box 23, NAM Papers, Hagley).

66. “A Memorandum Examining the Issue of, and the Arguments for, Social Security ‘Medicare,’” June 1963, Chamber of Commerce, Imprints, Hagley. See also, e.g., “Adding Health Benefits to Social Security: Are There Basic Conflicts?” June 1963, Chamber of Commerce, Imprints, Hagley Museum.

67. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Aged, Testimony of Karl T. Schlotterbeck, 88th Cong., 2nd sess., 22–24 January 1964.

68. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Aged, Testimony of Leslie J. Dikovics, 88th Cong., 2nd sess., 22–24 January 1964.

69. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Aged, Testimony of E. Russell Bartley [of the Illinois Manufacturers Association], 88th Cong., 2nd sess., 22–24 January 1964.

70. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Aged, Statement of the National Association of Manufacturers, 88th Cong., 2nd sess., 22–24 January 1964.

71. Marmor, The Politics of Medicare, 36–37.

72. Hacker, The Divided Welfare State, 243.

73. Minutes of the Meeting of the Employee Health and Benefits Committee, 24 May 1963, Box 23, NAM Papers, Hagley.

74. NAM 1964 Industry Beliefs, 1964, Box 215, NAM Papers, Hagley.

75. Minutes, 26 June 1964, Box 3, Chamber of Commerce Papers, Hagley.

76. Public Affairs Report, 27 January 1965, Box 49, NAM Papers, Hagley.

77. Meeting of the NAM Public and Private Benefits Subcommittee, 24 November 1964, Box 23, NAM Papers, Hagley.

78. Ibid.

79. “Facts About National Legislative Issues of Importance to All Americans,” 1965, Box 23, NAM Papers, Hagley; “Do We Need Medical Assistance for the Aged Under Social Security?” 1965, NAM, Imprints, Hagley; “Poverty: The Sick, Disabled, and Aged,” U.S. Chamber of Commerce Task Force on Economic Growth on Opportunity, 1965, Imprints, Hagley.

80. Washington Report, 15 February 1965, NAM Papers, Box 216, Hagley.

81. Meeting of the NAM Public and Private Benefits Subcommittee, 24 November 1964, Box 23, NAM Papers, Hagley (emphasis mine).

82. NAM Policy Report, October 1965, NAM Papers, Box 23, Hagley.

83. M. E. Feary to John Byrnes, 22 February 1965, Box 29, John Byrnes Papers, Wisconsin Historical Society.

84. Peter Swenson, “B is for Byrnes and Business: An Untold Story about Medicare,” Clio (June 2006).

85. For example, if a patient were to write a letter to a dentist requesting a less painful version of a root canal procedure, a third party reading the correspondence would not be justified in concluding that the patient would actually enjoy the surgery—the context is understood by both parties without being stated.

86. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Mark E. Richardson, 89th Cong., 1st sess., 10–19 May 1965.

87. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Leslie J. Dikovics, 89th Cong., 1st sess. 10–19 May 1965.

88. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Karl T. Schlotterbeck, 89th Cong., 1st sess. 10–19 May 1965.

89. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of George L. Cullen, 89th Cong., 1st sess. 10–19 May 1965.

90. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Aged, Testimony of Leslie J. Dikovics, 88th Cong., 2nd sess., 22–24 January 1964.

91. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Leslie J. Dikovics, 89th Cong., 1st sess., 10–19 May 1965.

92. U.S. Congress House Committee on Ways and Means, Hearing on Medical Care for the Age d, Testimony of Karl T. Schlotterbeck, 88th Cong., 2nd sess., 22–24 January 1964.

93. U.S. Congress Senate Committee on Finance, Sessions on H.R. 6675, Testimony of Karl T. Schlotterbeck, 89th Cong., 1st sess., 10–19 May 1965.

94. Meeting of the NAM Public and Private Benefits Subcommittee, 24 November 1964, Box 23, NAM Papers, Hagley.

95. See, for example, Hart, David M., ““Business” Is Not An Interest Group: On the Study of Companies in American National Politics,” Annual Review of Political Science 7 (2004): 4769; Martin, Stuck in Neutral.

96. See Marmor, The Politics of Medicare, 18.

97. See Swenson, “Varieties of Capitalist Interests,” 22.

98. Swenson, “B Is for Byrnes and Business,” 6.

99. NAM Political Files, Box 5, NAM Papers, Hagley.

100. Dear Colleague Letter, 1 October 1962, Box 32, John Byrnes Papers, Wisconsin Historical Society.

101. David West to John Byrnes, 18 November 1963, Box 34, John Byrnes Papers, Wisconsin Historical Society.

102. Memo from David West, 3 February 1964, Box 34, John Byrnes Papers, Wisconsin Historical Society.

103. John Byrnes to John Reynolds, 18 September 1964, Box 34, John Byrnes Papers, Wisconsin Historical Society; Reminiscences of John Byrnes, 1967, Butler Library Oral History Collection, Columbia University.

104. David, With Dignity, 126; Kooijman, And the Pursuit of National Health, 165.

105. Reminiscences of John Byrnes.

106. Marmor, The Politics of Medicare, 63.

107. Reminiscences of John Byrnes.

108. Harris, A Sacred Trust, 181, 186.

109. Ibid., 187–88.

110. U.S. Congress House Committee on Ways and Means, Executive Session on Medical Care for the Aged, 89th Cong., 1st sess., 2 March 1965.

111. David, With Dignity, 131.

112. Marmor, The Politics of Medicare, 63. An AMA official commented “I never thought we'd end up spending several million dollars in advertising to expand the bill” (Harris, A Sacred Trust, 188).

113. Marmor, The Politics of Medicare, 64 (emphasis mine).

114. Transcript, Lawrence F. O'Brien Oral History Interview XI, 24 July 1986, by Michael L. Gillette, Internet Copy, LBJ Library.

115. Harris, A Sacred Trust, 187.

116. Transcript, Lawrence F. O'Brien Oral History Interview XI, 24 July 1986, by Michael L. Gillette, Internet Copy, LBJ Library (emphasis mine).

117. Transcript, Douglass Cater Oral History Interview, 26 May 1974, by David G. McComb, Internet Copy, LBJ Library.

118. Transcript, Lawrence F. O'Brien Oral History Interview XI, 24 July 1986, by Michael L. Gillette, Internet Copy, LBJ Library.

119. Wilbur J. Cohen to Jack Valenti, 4 March 1965, Ex LE/IS, Box 75, LBJ Library.

120. Harris, A Sacred Trust, 190.

121. Recording of conversation between Lyndon B. Johnson and Wilbur Cohen, 11 March 1965, Citation #7141, Recordings of Telephone Conversations—White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

122. Kooijman, And the Pursuit of National Health, 178.

123. For more on the concept of a cross-class alliance, see Mares, The Politics of Social Risk.

124. As a coda to this discussion, one might argue that Mills was forced to include Byrnes's Part B idea in order for the bill to pass, even if Byrnes had not intended to assist Medicare's passage. However, as documented exhaustively, the 1964 election left no doubt that the administration's bill, King-Anderson, was sure to pass. Even on the very day Mills was about to execute his “three-layer cake” coup, LBJ was expressing his confidence to his vice president, Hubert Humphrey, that the administration's King-Anderson bill would easily pass in its current form. (Recording of conversation between Lyndon B. Johnson and Hubert Humphrey, 2 March 1965, Citation #7024, Recordings of Telephone Conversations—White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.) The minutes of the committee's fateful meeting on March 2, 1965, similarly contain no hint that Byrnes was anything but sharply displeased that Mills co-opted his provisions. (U.S. Congress House Committee on Ways and Means, Executive Session on Medical Care for the Aged, 89th Cong., 1st sess., 2 March 1965.)

125. “The Congress: An Idea on The March,” Time magazine, January 11, 1963. See associated correspondence in Box 277, Wilbur Mills Papers, Bailey Library, Hendrix College.

126. “Wilbur Mills Talks on Taxes,” National Business Magazine, August 1964; Box 410, Wilbur Mills Papers. For more on Mills and his relationship with business, see Zelizer, Taxing America.

127. Materials for Speech for the Arkansas Chamber of Commerce on January 1962, Wilbur Mills Papers, Box 784.

128. E.g., Speech for the Heber Springs Chamber of Commerce, Box 590, Wilbur Mills Papers; Speech for the Associated Wholesale Grocery, Box 591, Wilbur Mills Papers.

129. Speech for the Paragould Chamber of Commerce, Box 600, Wilbur Mills Papers.

130. See Speech to Little Rock Jr. Chamber of Commerce on November 4, 1965, and Speech to Arkansas State Chamber of Commerce, November 10, 1965, among others, Box 658, Wilbur Mills Papers.

131. Speech to the West Memphis Chamber of Commerce on January 15, 1965, Box 782, Wilbur Mills Papers.

132. Speech to the Kiwanis Convention, September 28, 1964. Box 592, Wilbur Mills Papers.

133. Speech to the Lions Club, December 2, 1964, Box 600, Wilbur Mills Papers.

134. See Zelizer, Taxing America.

135. See Smith, American Business and Political Power, 10–11; Culpepper, Pepper D., Quiet Politics and Business Power (Cambridge: Cambridge University Press, 2011); Martin, Stuck in Neutral.

136. Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 11 March 1965, Citation #7141 (emphasis mine).

137. LBJ asked Wilbur Cohen “Please get a rule [to report the Mills bill to the House floor] just the moment they can. You just tell them not to let it lay around, do that. They want to but they might not. Then that gets the doctors organized, then they get the others organized, and they damn near killed my education bill when they lay around. It stinks. It's like a dead cat on the door when the committee reports you better either bury that cat or get it some life in it.” (Recording of Conversation between Lyndon B. Johnson and Wilbur Cohen, 11 March 1965, Citation #7141, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.)

138. Ibid.

139. Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 11 March 1965, Citation #7141, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library; Recording of Conversation between Lyndon B. Johnson and Carl Albert, 11 March 1965, Citation #7141, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

140. Recording of Conversation between Lyndon B. Johnson and Hubert Humphrey, 2 March 1965, Citation #7024, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

141. Swenson, “Varieties of Capitalists Interests,” 4.

142. Blumenthal, The Heart of Power, 179; Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 3 June 1964, Citation #3642, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library.

143. Recording of Conversation between Lyndon B. Johnson and Wilbur Mills, 6 June 1964, Citation #3686, Recordings of Telephone Conversations – White House Series, Recordings and Transcripts of Conversations and Meetings, LBJ Library; Blumenthal, The Heart of Power, 180.

144. Incidentally, Mills and Johnson were ultimately right to expect that the public would view Medicare as an important achievement. After Medicare's passage, Wilbur Mills gained a reputation for being a “miracle worker” in Congress (“Mills The Miracle Worker,” Publisher's Newspaper Syndicate, 6 April 1965, Mills Papers, Box 275) and garnered widespread laudatory publicity for his key role in conceiving the program after decades of gridlock on the issue (“After 20 Years of Argument, House Tackles A Health Bill,” Atlanta Journal Constitution, 8 April 1965, p. 5, Mills Papers, Box 275. See also “Mr. Mills’ Elder-medi-bettercare,” Fortune, April 1965, Box 410, Mills Papers).

145. Huber, Evelyne and Stephens, John D., Development and Crisis of the Welfare State (Chicago: Chicago University Press, 2001). From a macro standpoint, Medicare represents a crucial historical case for Huber and Stephen's theory for another reason not discussed at length in this article. Though the New Deal is obviously an important historical case, the circumstances surrounding it make it ill suited to adjudicating disputes about the relative importance of business interests and power: there are plausible reasons that the Crash dramatically changed both business political power and business interests simultaneously, leaving it difficult for scholars to convincingly separate the many effects the Great Depression had on U.S. political economy. On the other hand, Medicare passed in 1965, even though there were no sudden changes in the economy that occurred between 1964 and 1965; only the election in November 1964 constitutes a plausible explanation for the sudden shift in the proposal's political feasibility.

146. See Skocpol, Theda, “Bringing the State Back In: Strategies of Analysis in Current Research,” in Bringing The State Back In, ed. Evans, Peter, Rueschemeyer, Dietrich, and Skocpol, Theda (Cambridge: Cambridge University Press, 1985); DeCanio, Samuel, “State Autonomy and American Political Development: How Mass Democracy Promoted State Power,” Studies in American Political Development 19 (2005): 117–36.

147. It is understandable that scholars remain unclear on Mills's “true motives” for the choice: by most accounts Mills's move was entirely unexpected by both his political allies and enemies at the time (see Blumenthal, The Heart of Power, for both a review of and a unique skeptical perspective on this claim). In addition, as discussed, nearly everyone at the time expected the program to pass, even without Mills's addition of Part B and Medicaid. The most promising hypotheses seem to be that Mills thought an expansive program would forestall the demand for universal healthcare more broadly and that Mills hoped to claim credit for introducing a popular program.

148. Frieden, “Actors and Preferences in International Relations.”

149. In fact, though historical scholars sometimes assume that access to archival material allows this problem to be surmounted with the greatest ease, the problem of preferences is probably particularly important for historically minded scholars to consider. Because historically minded scholars often study times of great change in politics and society, and such changes often coincide with dramatically different strategic environments for the actors involved, understanding actors’ true preferences or motivations during such historically significant periods requires particularly exacting empirical and analytic rigor about this problem.

150. Hacker and Pierson, “Business Power and Social Policy.”

151. Frieden, “Actors and Preferences in International Relations.”

152. Korpi, “Power Resources and Employer-Centered Approaches in Explanations of Welfare States and Varieties of Capitalism.”

153. Gerring, Case Study Research, 173. More generally, see also Aminzade, Ronald, “Class Analysis, Politics, and French Labor History,” in Rethinking Labor History, ed. Berlanstein, Lenard (Urbana: University of Illinois Press, 1993), 90113; Mahoney, James, “Strategies of Causal Assessment in Comparative Historical Analysis,” in Comparative Historical Analysis in the Social Sciences, ed. Mahoney, James and Rueschemeyer, Dietrich (Cambridge: Cambridge University Press, 2003), 337–72.

154. Adam Bonica, “Ideology and Interests in the Political Marketplace” (working paper, Stanford University, 2012).

155. See Samuelson, Paul, “Consumption Theory in Terms of Revealed Preference,” Economica 15 (1948): 243–53.

156. Frieden, “Actors and Preferences in International Relations.”

* I thank Sam DeCanio, Jacob Hacker, Sigrun Kahl, Theodore Marmor, David Mayhew, Thomas Paster, Eric Schickler, and seminar participants at Berkeley for their helpful feedback on this project. Any remaining errors are, of course, my own. Special thanks are due to the tremendously helpful and generous archival research staffs at the LBJ Presidential Library in Austin, Texas; National Archives in Washington, DC; the University of Virginia Miller Center of Public Affairs' Presidential Recordings Program, Bailey Library at Hendrix College in Conway, Arkansas; Wisconsin Historical Society in Green Bay, Wisconsin; Hagley Library in Wilmington, Delaware; Yale University Sterling Memorial Library; and Columbia University Butler Library. This research was funded in part by two Mellon grants from Yale University. I also thank the Beswick family, Mac Barnes, and Danae Steele for their hospitality. I finally acknowledge the National Science Foundation Graduate Research Fellowship Program for support.

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