When Kennedy Didn’t Compromise

Lessons from the senator’s early health reform failure

I join the chorus of those who have long admired Sen. Edward M. Kennedy’s remarkable Senate career and his persistence in pushing for health care reform throughout his forty-six years on Capitol Hill. Indeed, his negotiating skills and ability to wrest compromise from his diverse colleagues will be sorely missed as the Congress faces a crucial autumn fight on how best to overhaul our ailing health care system. Nonetheless, it is instructive to look back to the late 1970s, when an uncompromising Kennedy battled his fellow Democrats on comprehensive health care reform and learned firsthand how the perfect can be the enemy of the good.

Thirty-plus years ago, I was a young health and science reporter for The Washington Star, the late, great afternoon newspaper in our nation’s capital. Then, as now, Democrats ruled the White House and Congress, the economy was hurting, and there was widespread concern about skyrocketing health care costs. I spent countless hours covering Sen. Kennedy and his media-savvy hearings on the need for health care reform, as well as behind-the scenes visits with his staff in the Russell Senate offices to gather advance information for the Star’s early edition. I traveled the country reporting on hearings held by Kennedy on the need for national health insurance.

Back then, of course, Kennedy was a potential presidential candidate, so his every move attracted massive press attention. In what may have been a model for the modern era of media coverage, Kennedy’s staff created an emotional opening to each hearing, beginning with a poignant panel of average Americans whose lives had been ruined by their health problems as well as their lack of health insurance, and the financial ruin this had brought. These stories were catnip to the television crews.

As these average citizens told their stories, the cameras on Capitol Hill rolled, capturing moving footage that guaranteed a spot on the evening news. But then, as now, the television cameras usually disappeared once they captured their images, leaving behind a lengthy hearing awash with often dry testimony by a sea of experts from labor, business, medicine, the insurance industry, and the consumer movement. These hearings frequently dragged on into the mid-afternoon, but there was only one senator who was willing to stay from start to finish—Ted Kennedy.

Other senators came and went (perhaps aware that they were unlikely to get on the news as long as Kennedy, chair of the powerful Health Subcommittee, was there). He seemed tireless, prodding and asking penetrating, substantive questions that belied the sometimes shallow media portrayal in his early career that suggested he was the lightweight among the Kennedy brothers.

Even then, Kennedy understood how to elevate an issue and build legislative support for it: hire a great staff, gather evidence, publicize your work, and persevere over the long haul. His influential chief health advisor, a Stanford doctor and personal friend named Larry Horowitz, helped fire Kennedy up for these hearings (Horowitz was the person the Senator asked to manage his treatment after discovering the brain tumor that led to his death last week). The late Walter Sheridan, a former FBI agent and powerful aide to Bobby Kennedy, was masterful at tracking down individual citizens to make the health hearings come to life. Kennedy himself was extremely media-savvy, particularly during the late 1970s, as he tantalized the public—and the press—with the prospect that he too might run for president, as he eventually did when he announced, in November 1979, that he would challenge the seemingly vulnerable sitting Democrat, Jimmy Carter.

Looking back, I realize how much this intra-party fight for the 1980 presidential nomination stood in the way of getting health reform through Congress. Kennedy positioned himself as the standard bearer of a liberal movement that had reached its high-water mark in the mid-1960s with civil rights and health legislation, including the passage of Medicare and Medicaid legislation. He gave his first major speech on the need for national health insurance in 1969, and by the late 1970s was fighting hard against the more moderate President Carter, who sought a more incremental, phased-in approach to health reform.

Kennedy instead stood strong with the powerful labor movement that was so much a part of Democratic politics and was unflinching in the push for a cradle-to-grave universal national health insurance plan that would be run by the government. CJR’s Trudy Lieberman, in her fine column on Ted Kennedy’s health care legacy, said she had always wanted to ask him why he could not pass national health insurance and “why he was always compromising.” But it was not always thus. The spirit of compromise and skilled negotiation with his Senate colleagues on both sides of the aisle that later characterized his long and successful legislative career was not in evidence as he put universal national health insurance in the forefront of his push for the Presidency.

When I traveled with Kennedy and his staff outside Washington while covering the national health insurance issue, I had a lot of personal access because few reporters chose to make those journeys. I was always impressed at the senator’s seriousness (combined with a fun, enthusiastic spirit and camaraderie with those around him). His sense of humor was evident in an incident that Joe Califano later recalled to me in a 1993 interview for The Washington Post as the Clinton health care plan was being developed. As Carter’s Health, Education and Welfare secretary in the late 1970s, Califano had said publicly that Kennedy’s universal health plan had no more chance of passing than putting an elephant through a keyhole. The next day, Califano received a poster board with a large keyhole and a little pink elephant swinging on a string; the accompanying note said, “Dear Joe. It looks like it fits. Ted.”

In the end of course, neither Sen. Kennedy’s hard-line push for national health insurance nor President Carter’s more moderate, phased-in approach prevailed. That failure, of course, was due to a combination of factors: timing; Carter’s weakness as president; the struggling economy; powerful health lobbyists; resistance, then as now, in the Senate to overhauling the system; and Kennedy’s own unwillingness to compromise. Califano acknowledged that one of the many failures of the Carter administration was the decision to send welfare reform to the Congress first in 1977, for an unsuccessful fight that lasted two years and probably harmed the chances of health insurance passing later in the term. And in the Senate, another larger-than-life figure stood in the way of Kennedy’s dream: the powerful chair of the Senate Finance Committee, Russell Long (D-La.), who advocated far-more-limited catastrophic health insurance coverage that was less than the moderate, phased-in plan proposed by Carter.

That may be the tragic legacy—Democrats fighting each other in the late 1970s rather than passing some form of health care reform legislation. As a country, we would certainly be better off with moderate health care reform starting thirty years ago, when health consumed about 8 percent of the GDP, than with the mammoth challenges we face today: national health care spending has doubled since then and is now gobbling up about 16 percent of GDP.

What we got instead from the Democratic infighting was the Ronald Reagan presidency and a whole new era of Republican rule. It was in the Reagan era that I saw the evolution of a new Kennedy. Yes, he assumed the familiar mantle as the liberal leader in the era of Republican backlash. But, with the Republicans now in control of the Senate, he was in the minority party for the first time in his career there and increasingly reached out to those across the aisle. I saw Sen. Kennedy emerge as a close colleague of conservative Sen. Orrin Hatch (R-Utah), who was elected to the Senate in 1976 and jumped to the chairmanship of the Labor and Human Resources committee in 1981 when the Republicans gained control. While Hatch and Kennedy disagreed on much, they found common ground on issues like HIV/AIDS, consumer drug legislation, children’s health, antismoking efforts and funding for biomedical research.

As I look at the 2009 attempts to bring major health care reform to the United States, I hope that the Democrats’ past failures to overhaul the health care system will be a telling reminder that this time could be different. Will the passing of Ted Kennedy inspire our nation’s legislators to find a meaningful compromise that can advance the holy trinity of health reform—increased coverage, reduced health cost inflation and higher quality—even if it still leaves important health problems unresolved? Put simply, can today’s highly partisan Congress enact a bill that helps America’s citizens achieve access to high quality affordable health care? Or will history continue to repeat itself with the Congress, including the fractious Democrats, unable to pass a bill that moves the health care system in a good, if not perfect, direction?

This time around, the politicians on Capitol Hill will have to go it alone without the older, wiser lion of the Senate, the health care reform idealist who became a health care pragmatist as well. This time around, when the time comes for cutting a deal, many politicians on Capitol Hill will undoubtedly be asking themselves, “What would Ted do?”

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Cristine Russell is a CJR contributing editor and the immediate past-president of the Council for the Advancement of Science Writing and a senior fellow at Harvard's Belfer Center for Science and International Affairs. She is a former Shorenstein Center fellow and Washington Post reporter.