Ted Kennedy’s Health Care Legacy

Reporting on the lion

I met Sen. Ted Kennedy only once. He showed up one winter night at the home of former Labor Secretary Robert Reich in Cambridge, Mass., to talk about what the Democrats could hope to accomplish under the regime of George W. Bush, who had just moved into the White House. That semester I was a fellow at Harvard’s Shorenstein Center, and fellows got to go to cool meetings as long as everything was off the record. Kennedy introduced himself to me, shook my hand, and asked me lots of questions. He had that politician’s knack for making people feel special. Over pizza and wine, Kennedy was pessimistic that evening, saying that nothing much would happen on health care or anything else under the Republican administration—except for education. He thought there were some possibilities for compromise there.

I always wanted to sit down with Kennedy, one on one, and quiz him about why, despite his best efforts early in his Senate career, he could never manage to bring national health insurance to America like every other Western country has. I wanted to ask him why he was always compromising, and why he thought the results of those compromises were the best that the wealthiest, most technologically advanced country on the planet could muster. But I never had the nerve to ask for the interview.

So through the years, my interaction with Kennedy was as a health care journalist, critically covering from afar the compromises and the laws that he did managed to shove through Congress: the Health Insurance Portability and Accountability Act (HIPAA) in 1996, the State Children’s Health Insurance Program (SCHIP) in 1997, the Medicare prescription drug law in 2003, and the Massachusetts health reform act in 2006. Even when those laws, with their loopholes and shortcomings, are seen through the lens of the deteriorating efforts to enact other health care reforms, they seem monumental indeed.

In a 1997 article entitled “You Can’t Take it With You,” we at CJR were critical of HIPAA, known as the Kennedy-Kassebaun (for ex-Kansas senator Nancy Kassebaum) bill, and the way the press covered its passage back then. That law was supposed to make it easier for people who had job-based insurance to keep their coverage when they left their employment. Insurance companies then, as they will surely do now, fought hard to retain the right to weed out sick people, and thus they managed to limit the law’s value. So in the end HIPAA become best known for its onerous privacy restrictions that give us health reporters fits. Still, HIPAA does to help some people who know how to preserve their rights under the law and stay on top of the deadlines it imposes.

The fact SCHIP passed at all during the turbulent Clinton years—in Newt Gingrich’s Congress, no less—was a testament to Kennedy’s negotiating skills. Millions of uninsured kids suddenly could get health care—check-ups, vaccinations, hearing tests, and antibiotics for strep throat. Millions more children need the same care, but the law (and its extension passed earlier this year) still leaves medically needy children uninsured—an issue that has been lost in the political thicket. Kids’ health is still at the mercy of state budget shortfalls—as we have seen in California, where thousands of children have been cut from the SCHIP rolls during the state’s latest fiscal crisis.

Senior citizens who complain about Medicare in the town hall meetings would do well to remember that Kennedy was instrumental in passing the law giving them the prescription drug benefit that now helps pay for their medicines. Before the law passed, they were the only large group of Americans who had no assistance paying for their drugs. (Employed people usually had drug benefits from their employers that kept their costs relatively low.) Though the law is far from perfect—it prohibits the government from negotiating cheaper prices from drug companies, and people with large drug expenses must shoulder those costs when they reach the limits in the so-called donut hole—no senior would want to be without it.

And then there’s Massachusetts, where Kennedy helped engineer the compromise that brought health insurance coverage to most of the state’s residents. As we have pointed out in our series Health Reform Lessons from Massachusetts, not everyone in the state is pleased. Mistakes have hurt the safety net hospitals, tax penalties have hurt uninsured residents, and, most important, the lack of serious cost control coupled with run-away medical costs threaten the law’s long-term viability. In the end, Massachusetts may not be a model for the rest of the country. But there’s no denying that, in the meantime, thousands of people who needed medical care have received it over the past few years.

Reviewing all this in the context of the current nasty, exceedingly partisan, and manipulative rhetoric about health care makes me think about what Kennedy might have said if we had had our interview. He probably would have said it was better to help some people and keep trying for more down the road. He might have said that journalists need to continue reporting on the laws he did manage to pass, and what’s needed to make them better.

It would be great for news outlets looking for a respite from town hall shouting matches to use the occasion of Kennedy’s death to remind their audiences of what the HIPAA law can do to help them. It would be helpful for them to put the drug companies’ deal with the president in the context of the shortcomings of the prescription drug law. Writing about all those kids left out of the SCHIP expansion may help remind why universal health coverage, no longer the objective of health reform, is still important. And reporters need to examine and re-examine what’s really happening in Massachusetts, especially if Congress tries to replicate the provisions of its law without addressing its considerable problems.

He might have reminded me of what his brother Bobby once said when he paraphrased George Bernard Shaw: “There are those that look at things the way they are, and ask why? I dream of things that never were, and say why not?”

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.