Conversation 498-003

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Yeah, okay.

That's one of the best places in the world.

Thank you very much.

No, at Dartmouth, Mr. President.

Dartmouth is northeast of here, Mr. President.

You'll come into, as you, of course, know, a very challenging position, all-in-all position, we talk about.

This is the other thing that comes to mind.

health care, you know, you'd be right in the middle of it.

You'd be damned by this.

Praised by Jews.

They've done it for most of our doctors.

And in a very unpolitical sense at all.

And so even though we're saving them from a fate for which that is worse than death, they will only give us damn little support.

So we'll be out there fighting a pretty lonely battle for what really is

And we hope to win it.

But beyond that, the partial or the actual challenge is that the tradition of all the research on this cancer traffic

Got it.

You better be good, Al.

This is a tough job.

Oh, yes, you'll be great, Monty.

You'll be great.

Merlin K. Duvall was always Monty.

Is it still Monty?

Yes.

Yes, there was a villain on the Jack Armstrong radio show here in the 30s, and his name was Monty Duvall, and that's where it came from.

It's been that ever since.

You were on that piece?

Yes, sir, New Jersey.

Yes, I was.

As you said, we had a little move for seven years, moving west in Oklahoma, and sort of adopted Arizona, I suspect, at the appropriate time of our return there.

I live there.

We've come very far to Mexico.

We go there.

It's all just fun.

We're very much at home in Mexico.

We travel back and forth freely.

My wife does very well with Spanish, and we have a lot of friends down in the small town as well.

We're doing good.

No, really, I think it's an excellent investment.

It's a stable country, one of the few in Latin America that has this stability.

And to make sense of the deal, that means you should really have some property there.

You've got to get to know the Mexicans.

And so many people, particularly in my state of California, I mean, they don't look down their noses at Mexicans.

Here in the East, as you know, everybody's obsessed about the blacks.

And the Mexicans are put upon much worse than the blacks, from an economic standpoint.

They're in a horrible condition.

Los Angeles and other places.

But they have such quality.

They can't manage anything very well.

That is, generally speaking.

They can't do anything real.

But on the other hand, they work.

They're loyal.

They have a...

They have warmth.

They have warmth, but it's very real.

I mean, most of the Latins are poets.

And they're very moral.

That's true.

It's true.

We also think it's quite different.

It is very, it's really quite different from the black problem.

It's a different, the blacks also have very great assets.

The Mexicans, only those who live with them and know them can appreciate it.

I went to school with them, of course, in California.

You know what I mean?

You'll have a chance, Tom, to get out there about every eight months or so.

All right.

There's problems in Arizona, too.

And, uh, a lot of those migrants, those people are Indian.

Actually, they're the Indians.

Of course, that's a big problem.

But really, seriously, you will have to go to Los Angeles.

We discovered in the course of the development of the health program, which you submitted to Congress in February last year, that my three detectives had never really

followed through with the designation of the Inspectorate of Health and Sanctuary Affairs as a client officer by giving him the staff capability for comprehensive planning and program development in health.

John was basically an advisor, but he was not enough.

He didn't have the staff to operate.

He was said to be in

in charge of the health agency.

But wasn't.

But he wasn't, really, and one of the reasons he wasn't was that he didn't have the staff capability to carry out the function.

Why was that?

Has that always been the case, or was it just when we came in?

No, well, the job was originally, when the, when the next section went through, we ended up sending a task to work with the administration on the issue, which was

very intensely, followed by the AMA.

They were intensely involved in the question of what the state assistant top health job would be.

They didn't want it a line job.

And they didn't even want it an assistant secretary's job.

So it became the job of special assistant to the secretary for health affairs with the rank of assistant secretary and no line function.

Well, eventually John Gardner changed that

to convert the job into a line of office and place the operating health agencies under it.

But in the interval since Gardner did that, and several people who held the job from then to date, it was a largely nominal role because it never did acquire the staff capability necessary either to do

an effective managing job, or to do the job of developing the database and the analytic capacity for program and policy development.

The result was that I really sort of fell into the situation last summer of taking on responsibility to you, General, in the development of the health program, but never realizing, and anyway, that we didn't have the bodies there in the health-based part of the department.

How did you work on the program?

Well, we co-opted.

You, of course, know the program, and I remember it went through various stages, but...

and we'd be here about how the welfare program was developed, and that was a lot of work.

But when you write the history of this time, the health thing is about as tricky as anything we've come up against.

Did it come up just to have a...

I know Eggler didn't do it.

He worked on it, but he didn't have the staff to do it.

So how did you work it out?

We had a lot of people, Butler and...

And then we borrowed people partly from the White House staff, some of the White House staff worked very closely with us.

Because John Irvin would certainly attest that it was as

Well, he said the Battle of Waterloo, a damn near-run thing.

And we hadn't had the deadline, which seems the essential.

We had to get some program up by the middle of February.

If we hadn't had that up there, they needed eight months.

We wouldn't even be in the ballgame.

Oh, and so he exposed the need.

One of the reasons I'm going to work with this is that it's supposed to need to develop both the role that Dr. Duval is requiring and also the staff capabilities he will need to do it as the senior health officer, drawing on all the agencies, I think, not only with the HW, but cooperatively with others outside of it in the development of a more unified, comprehensive policy planning capability within the government.

We're getting so big, even now the federal government accounts for maybe a third of health expenditures.

And with new programs, we would indirectly affect more.

So we have to have the capacity to think through the consequences of what we do and see it as an interlinked system.

So, what was the train again?

A series of... A series of insolvable problems.

Really insolvable problems.

This is a great conversation.

Yeah.

There it is.

Insolvable problems.

They tell us, NIH, NIMH, some of those entities, have given us the appearance of being

more or less autonomous .

And we run into real problems, for instance, in the narcotics area, because NIMH is sort of unto itself over there.

And if you get into interdepartmental problems, we don't have quite the same relationship that we do with a secretary's organization in a department.

We hope that Dr. Duvall can get a line around some of those things.

He'd like you to, my will.

We'd like you to.

No, this is awfully important to us.

Well, there's been a long history, you know, related to Mrs. Lasker and the annexes and so forth, and Jim Shannon, that we're still recovering from and speaking, but this deserves a more rational alignment that's had to pass.

Well, this is subject to the Secretary, but I would look for my part, that we could feel every morning when we woke up that we knew pretty well what NIH and NIMH were going to do that day.

And as it is now, it's anybody's guess.

Well, you made a lot of me.

We are making progress.

Oh, you've come a long way.

Marston, for example, who has a difficult mind to walk, has been very...

This is...

He's the NIA director who came up with the idea.

He's a great story.

I thought that he's been doing well.

He's got a very big heart.

He's a great man.

Well, they have the same kind of problem.

He's a good soldier, but he's got to have some kind of commonality with his constituency and the troops that he leads.

We've done a very tough thing in narcotics in rallying together the Department of Defense in their efforts, AGO in their efforts, and the Department of Justice in their efforts.

And it seems the only way we can effectively do that is to quote all we hear at the time.

And what do you think, for example, of the waterway defenses?

At the present time, Europe says that the problem here is not whether we're going to withdraw forces, but whether we're going to do it by drugs.

The moment they arrive, over half, within maybe two hours after they are, whatever they do, get their uniforms and so forth,

It does mean, however, that just as we all remember when we were in the service, or we remember when he went on the convention, but you're on a plane.

So you're in town, and it's easy to go out in the business.

much further than they would if they were home and they go, and you are home.

So I think the defense thing is terribly important to pull that in.

Pull that in and make it somewhere to a coordinated deal.

Let me say another two things.

Of course, the United States is not a publicity independent answer thing.

We're all, we're all intelligent enough to know that.

We may not find a quick answer.

Certainly there may not be an easy one to find.

But we'll do something, something.

Progress has been moving along here for some time.

But the reason that we set up the way we did from the standpoint of public information is to concentrate public attention dramatically on a field of research and health care and so forth, which everybody can understand.

And the only way you can concentrate that dramatically is not simply say, well, we're going to put another few, $20, $30, $40 million into an existing agency where they think it all goes down the rabbit hole.

But to say, now, this is going to be different.

Now, it is going to be different because I actually said, now it's going to report to the president and I'm going to watch and so forth and so on.

But I must count on, on the other hand, I've got to count on

The experts, you out there, and whoever that, who was that called?

Marston.

You say he's very good.

Yes, sir, he's excellent, and very good.

Well, the point I mean is we've got to, you fellows are going to hate this, but rather than just, the main thing you must not do in setting up your own now little bureaucracy is to become part of it.

All of all people who come to Washington have the great

Bureaucracy is so big, it's like quicksand.

You step into it, you think you're going to make it and all that sort of thing, and then you just submerge and become like all the rest.

You do that, you fail.

Now that doesn't mean that you don't work with the existing people, bureaucrats and their loyal civil services and that and the other thing.

But it isn't the way that he tries to get things done.

Sometimes you've got to shake them, kick them, twist them, and so forth.

Don't just, it's the...

95% of the people who come into government come here saying, well, I'm going to change this, and then end worshiping the bureaucracy.

That's true of the State Department people.

I mean, the Foreign Service.

It was once said, you know, I would say, talking to an old Foreign Service officer recently who is now retired, and he pointed out, he said that in the 20s and 30s when he was in the Foreign Service, it was the Foreign Service of the United States of America.

And

Then he said, in about the, during the 50s, it became the Foreign Service of the Secretary of State.

Now it's the Foreign Service of the Foreign Service.

Now that is an unfair, perhaps, description of many Foreign Service officers, but it's not far from the mark.

The difficulty is that in every, it is true of the most highly talented, that every person who works in any kind of assistance

becomes so enamored with the system isn't so much a part of it that he fights for the system rather than getting something done and uh the best thing an outsider can do is to come in and use the system and not have the system use him that's the real question that's what elliot's been doing you've got it's it's great command you've got to very subtle because if you set yourself up as against those who are in the system they'll kill you so you've got to use uh

But not let them know you're using them.

But by all means, never let them use you.

You must never let them use you.

When I say let them use you, I'm not talking about any particular individuals.

But the great majority really, because they are basically not big men, are part of it.

And they're petrified at the thought of seeing it change.

It's petrified because it affects their lives.

So you've got to come in and hear it.

And talking about the system, of course, the other side of the system is not only guidance and practice.

The medical profession is the system.

And, well, God knows I would take our medical system over anything in the world, even as it is.

Because, as I say, I'm not interested when I get sick as to whether somebody's going to pay the bill.

I want to be sure I get a good doctor.

And their system's all health.

Burma, they've got free medicines.

that God helped you to get sick in Burma, and kill you.

But so, what we want here is not the pennies-free medicine.

What we want is, it's got to be something that'll work with the existing troops that we've got.

But believe me, Elliot has heard me say it, and so has Hector, we've come to realize that our doctors are, frankly, they're the worst enemies.

I told him years ago, Elliot will remember this, Chris Herter and I and a group of several others got together when I was in Congress in 1948.

We came up with a health care plan.

Which would look very, very conservative today, punishing the American medical profession, saying it was as radical as the Sorbets lunch report.

Do you remember that, Jess?

Oh, yeah.

You quoted her.

Yes, I did.

What was it?

It was Republic.

We called it the Republicans.

Who was the man in the magazine that worked with us on that?

I don't know.

You recall, he had the fish...

The Lion?

No, no, no.

The Lion.

Oh, Russell, Russell Davenport.

Russell Davenport was with us.

He was the guy that here we are in Congress.

And we worked this thing out.

They killed him.

Now, the difficulty is that in present time,

They met in the profession and we were talking to them day and night and all the rest of the time.

And I'll say, this is a terrible program.

This is too far.

It's not good.

You've got to say, all right, what do you want?

Do you want to do this?

Or do you want to have none?

And have senators and congressmen go down that aisle and do what is popular.

And what is popular is to sing for the Hawkers.

The great majority of the American people, if you really put down, are you for free medicine or not free medicine, are you for it?

Do you think doctors are overpaid?

Yes.

They're happy to be wrong if it's for the house.

That's what they feel.

So that is why Elliot, for a purpose, I call him that, because it really is his.

That's why this is enormous.

It's an enormous opportunity for these people.

He's got a lot of them coming along, the medical profession.

uh, well, we don't want them to be too evident in their support because it'll look like it's too selfish, but they sure as hell shouldn't get this.

Right?

And they ought to, they've got, you know, a huge, uh, slush fund for congressmen and senators, and they ought to support congressmen and senators who are going to vote right on this stuff.

Don't you agree?

Yes, Mr. President.

You've got to hear this.

Oh, all right.

Monty knows I spent 10 years, Monty knew I was in the House, but I'm not the person you're working with.

with Dr. Duval in connection with winning support for your health program, not only on the supply side, but also on the question of the coverage side, because it is very comprehensive.

It is a solid program.

It is basically centrist in its philosophy.

It eschews all of the troubles that you get into with the radical approach of Teddy Kennedy and with those who would say, let's do nothing.

So Monty and I, I'm sure, will work very well together, Mr. President,

in developing the strategy to win support.

Well, the main weakness of the Kennedy program is not its cost.

If the country blighted, that's what the priority should be.

You could find a way to finance it.

The main weakness of the Kennedy approach is that, if I put it that way, is that it would destroy the system.

It throws out the good with the bad.

And so you can't do it.

That's all we can do.

There is, of course, a

I'm only guessing, I can see, but I think you may be pleasantly and warmly surprised that they will begin to shift their position.

And I believe that some things that I have in mind will be very helpful in moving them.

They are very sensitive, and they're prepared now to be led.

I think the main thing you can get across to them is that you can say that they have now an administration that is frank.

We are their friends.

We are not their enemies.

We will not demigod.

We're not going to destroy them.

We're going to help them.

But unless they work with us, when they have their friends here, they'll read the world.

All right, Mr. Deere.

Mr. Deere.

Thank you, sir.