Gov. Bobby Jindal says a career in politics was his Plan B.

He was preparing to be a neurosurgeon when he won a prestigious Rhodes scholarship, so he put medical school on hold for a couple years to attend Oxford University. It was there that Jindal was challenged by legal philosopher Ronald Dworkin, an ardent Democrat described as “bracingly liberal,” to think of medicine from a policymaker’s perspective, rather than as a doctor.

In the now-famous story, Jindal set himself apart among the eager college interns working for then-Congressman Jim McCrery, R-Shreveport, by writing a paper on Medicare. He was only 24 when Gov. Mike Foster tapped Jindal as Louisiana’s health chief. He went on to work on a congressional commission that was trying to revamp Medicare. As governor, Jindal privatized the management of most of Louisiana’s historic charity hospitals and contracted private insurers to oversee health care for the poor.

That policy was the subject of the first “white paper” of the think tank that many, though not he, say was formed as part of a future run for the presidency by Jindal. The America Next report, which was published in April, and which Jindal says is the statement of his current thinking, uses a lot of the same phrases and syntax seen in his Oxford dissertation that was written in April 1994.

Jindal said in an interview last week that rattling around in his head as he left for England in the early 1990s were the frustrations voiced by aunts, uncles and cousins who were doctors. But he also heard about how gratified they felt from work that improved the lives of individuals every single day.

The Clinton White House at the time was trying to revamp America’s health care system, so naturally Dworkin discussed accessibility in class. Dworkin applied classic liberal philosophy to the legal issues of the day, such as race and abortion. His positions were “grounded in his belief that law must take its authority from what ordinary people would recognize as moral virtue,” wrote The Guardian, a British newspaper.

About the only thing Dworkin and Jindal agreed on was that morality should underlie government policies. Despite their differences, Dworkin took Jindal under his wing and helped the future politician develop the language to articulate his positions. “I ended up spending more time thinking about policy,” Jindal said.

His 1994 thesis — or, more specifically, its title, “A Needs-Based Approach to Health Care” — is mentioned in nearly every biographical sketch. Oxford requires the signed permission of its authors before releasing the thesis reports of former students. After six months of requesting, Jindal signed the permission, and his press office released a copy to The Advocate.

In his dissertation, Jindal argued that Judeo-Christian ethics require universal health care, but the spiraling costs require taxpayers to make choices on what services should be included. “The rights-based theory specifies which health-care interests must receive funding by transforming them into rights,” Jindal wrote 20 years ago.

He said health care is universal and should be provided to everyone, even criminals and people who have contributed to their own bad health, such as smokers. But he says the high costs mean that some decisions have to be made on just what services are provided.

Jindal today says that he still holds that belief. (Well, not the part where he wrote cigarettes should be taxed in order to raise money to address the health issues the habit creates. “A lot things I wrote back when I was in school, I was in the ivory towers, don’t make sense out here in the real world,” Jindal said, chuckling at the irony of his opposing the renewal of 4 cents of Louisiana’s cigarette tax.)

Over time, says Jindal, his emphasis has shifted from what services to provide to how services are provided.

Jindal says government can’t adequately provide universal health care. Government’s role should be to work with and provide help to the states, which would create the mechanisms and incentives to attract wider participation among private physicians and clinics and to address specific local needs. “Simply giving someone an insurance card and pretending they have affordable access isn’t enough,” Jindal said.

What hasn’t changed over the years is his belief that health care should be available “to all our people. It’s a question of human dignity,” he said last week.

Mark Ballard is editor of The Advocate Capitol news bureau. His email address is and is on Twitter @MarkBallardCNB. For more coverage of government and politics, follow our Politics Blog at