Nearly 40 years ago -- less than a decade into his time in office -- Senator Ted Kennedy chose to tackle what would eventually become the "cause of his life." He almost succeeded.
The push for universal health care coverage had been given a big boost with the passage of Medicare as an amendment to the Social Security Act of 1965. But within five years of the law's enactment, Kennedy, who had assumed his Massachusetts Senate seat in 1962, was pining for another bite at the apple. So starting in 1971, he began pushing for comprehensive legislation that, for the price tag of $60 billion, would have set up a government-run health care system to cover all Americans.
It was an ambitious move, but one that Kennedy felt morally and politically obligated to take. Years earlier he had grown personally attuned to the benefits and pitfalls of the health care system after he broke his back and nearly died in a plane crash. After that, he helped pass a law establishing community health centers. Despite improvements, he had concluded that more needed to be done to make health insurance available and affordable.
Over months and years of negotiations, backroom dealings, and political firestorms, he and his allies came closer to passing a comprehensive bill than any other team of lawmakers before, and, until recently, since.
It was the senator at his best, deftly traversing complicated political terrain, mastering the intricacies of the congressional process, and bringing different philosophical camps under one roof. But it was also a moment that symbolized the frustrations of Kennedy's time in office. In a career filled with incredible legislative achievements, the senator's death on Wednesday sadly ensured that he would never see the fulfillment of the defining policy objective of his career.
"In retrospect, 1974 was the closest we have ever come to enacting national health insurance, and Democrats made a great mistake by not eagerly embracing [President Richard] Nixon's proposal," said Paul Starr, a health care policy expert and professor at Princeton University. "The distance between Kennedy and Nixon then was so small by comparison with the distance that exists now between Democrats and Republicans."
In the early 1970s, two prospective pieces of health care reform were competing for public support. The Nixon plan was structured largely around the private market. It included an employer mandate for coverage, shifted a portion of Medicaid to a private insurance system, and set up pools of insurance to provide low-cost coverage to some 30 million Americans. It also grew to include greater government involvement in providing insurance to the uninsured.
Kennedy had different ideas. "The president's program," he declared at the time it was revealed, "is really a partnership program that will provide billions of dollars to the health insurance companies. It is really a partnership between the administration and the insurance companies."
In its place, the Massachusetts Democrat pushed what was, in essence, a single-payer system. A bump in Social Security and other taxes would pay for an expansion of a national health care service. The program would cover some 70 percent of costs for consumers and would be operated by a presidentially appointed health security board.
If the policy divides seemed un-bridgeable, politics only complicated the matter. Kennedy, at the time, was rumored to be a contender for the 1972 presidential race, even though his infamous car crash in Chappaquiddick still clouded the picture. He would ultimately brush away the speculation. But soon thereafter, Nixon became embroiled in the Watergate scandal.
And yet, over time, the two camps moved closer to one another. Nixon's ethical troubles, it turned out, had a positive effect on health care's prospects. The White House, as Jill Quadagno wrote in "One Nation, Uninsured: Why The U.S. Has No National Health Insurance," wanted to show that "the government [was] not paralyzed." And it needed a boost of support from the voting public. Kennedy had a partner with which to work.
A legislative tango ensued. Recognizing that single-payer didn't have the votes, the senator set up secret meetings with Congressman Wilbur Mills (D-Ark.), to put together an alternative piece of legislation, one that had the health insurance industry serving as intermediary in a still largely-government-administered system. Once that was accomplished, Kennedy set up another secret meeting, this time with the president and his advisers.
"He wanted to see if they could find a three-way compromise," recalled Stuart Altman, a health care adviser to Nixon, and highly respected expert on the subject. "It was the beginning of what became known as the Kennedy mystique. He clearly is a liberal; he was a liberal; he strongly favored liberal position. But he never let his ideological position cloud him from getting things done that would help people."
But as the main actors grew closer, external forces were pulling them apart. As Altman explained, Health, Education and Welfare Secretary Caspar Weinberger pushed back against many of the concessions that the congressmen were demanding. The American Medical Association decried the Kennedy-Mills bill as "socialist." The National Federation of Independent Business, meanwhile, deemed it "nothing more than a first step towards socialized medicine."
The real pushback, however, came from the labor community. As Watergate cast a shadow over the Nixon presidency, unions began asking why compromise was needed in the first place. "They wanted the insurance industry out," said Altman. "They were convinced that they would win the presidency in 1976 and they just said no. And so, they essentially left Kennedy out to dry. And the same thing with the conservatives. They were flabbergasted that Nixon was willing to go as far as he did."
Even after Nixon resigned, Mills pressed forward. Moving even closer to the then former president's outline, he put legislation to a vote in the House Ways and Means Committee in 1974. It passed by a 13-12 vote -- a historic breakthrough but still a narrow one. The congressman was wary of moving anything to the House floor without a bigger majority. But before that could happen, the wheels fell off. As Quadagno writes:
On October 7, the police stopped his Lincoln Continental, which was speeding with the lights off at 2 a.m. Mills staggered out, bleeding and drunk. Then his passenger, Annabel Battistella, a stripper who preformed as Fannie Fox, jumped out of the car and leaped into the Tidal Basin. Mills won reelection to the House in November despite the scandal, but Democrats divested Ways and Means of its power to delegate committee assignments. Soon after Mills appeared drunk onstage at Fannie Fox's first appearance at a Boston strip club, he lost his chairmanship.
With Mills disgraced and Nixon no longer around, Kennedy was caught in limbo. The Senate Finance Committee had pledged to get a health care bill passed, but special interests -- from the private insurers to the labor unions -- were taking their toll. With Gerald Ford in office, there was a renewed promise to consider reform. But when the economy worsened, that too passed. The election of Jimmy Carter in 1976 brought a brief sense of hope. But the Georgia Democrat, much to Kennedy's chagrin, favored a piecemeal approach.
"Nixon got in trouble, as we all know," recalled Bob Shrum, a longtime Democratic strategist and Kennedy friend and adviser. "Wilbur Mills got in trouble, and his successor didn't care much about doing this. I think Ford was maybe open to trying again. But then there was the Ronald Reagan challenge. It just wasn't there. But it almost got done."
Twenty years later, Bill Clinton's plans for health care ended up resembling the compromise approach that Kennedy and Mills had negotiated with Nixon. Then too, Kennedy played an active role in trying to get reform passed. But the process never got as far along as it had in the '70s.
The lessons that Kennedy had learned with Nixon -- namely that broad consent and consultation was needed to move legislation forward -- was lost in the battle.
This time around, Kennedy's involvement was limited by his struggle with brain cancer but he remained a relatively active participant.
"He was distinctly frustrated at not being a part of the effort this year. He expected to be, even after his tumor," said Adam Clymer, a Kennedy biographer and New York Times reporter. "He expected to be part of it. He was sure he would be back. Obviously his health was not as good as it could be and he wasn't a part. He coached Sen. Chris Dodd (D-Conn.) from the sidelines. And, he certainly pressed the president to keep the faith on it."
But as Kennedy's health dimmed, so too did prospects of reform. Despite an approach to health care that the Obama White House has attempted to keep inclusive, familiar political schisms have developed around perspective legislation. And now, the wily veteran of the Senate is no longer around to pull it all together.
"We are really going to miss him," said Altman, "because I'm convinced that had he been a strong, active and supportive person, he would have been able to mold us to the middle. And my concern is that the ideologies of the right and left are playing out just the way they did in 1974."