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?