How (and Why) Ted Kennedy Might Have 'Compromised' on Healthcare Reform

Sen. Ted Kennedy was known to lament his decision not to accept Richard Nixon's 'offer' on health care reform to impose an employer mandate to get the country close to universal coverage. He need not have wasted his remorse. Nixon's transcripts expressing shameful indifference bordering on a near-wish that Kennedy might be shot suggest that "Tricky Dickie" would have not lived up to his side of the bargain anyhow.

The eulogies at Ted Kennedy's funeral shared common themes that added up to this: that this was a man of great principle, dedication and hard work; possessed of a sky-high emotional intelligence; who was able to fashion compromise without surrendering his principles by employing that emotional IQ to determine what his opponents really needed, as opposed to what they might be saying, in order to achieve results. As a consequence, the "Lion of the Senate" played major roles in the National Cancer Act (1971), the COBRA Act (1985), the Americans with Disabilities Act (1990), the Ryan White AIDS Care Act (1990), the Health Insurance Portability and Accountability Act (aka, HIPAA; 1996), the Mental Health Parity Acts (1996 and 2008), and the State Children's Health Insurance Program (aka, S-CHIP; 1997), among others

As detrimental as the noise and shouting and misrepresentations and outright lying has been to the health care reform 'debate,' they would have provided Senator Kennedy the key insight that would have shaped the compromise and enabled the bill to pass. That insight was that the oppositions' emotional power springs from the (unfounded) fear of a "takeover", of "messing with one's life", of "federal power" of "elites" telling the common man what to do. Whether it was the [non-existent] death panels, the [non-existent] bureaucrat with his hands on the surgeon's scalpel, the [non-existent] campaign to kill grandma, the phony analysis of 112 million people transferring to the public plan and thereby gutting private insurance and thus choice -- all the fear was generated by raising the specter of centralized and unaccountable power (with the added element, of course, of a black man wielding it) of the federal government.

Those who genuinely 'fear' any of this are certainly a small minority. But, there are many many more who, while they do not actually fear, have enough doubt that they cannot completely exorcise their uneasiness, and thus tend to join the truly misguided in opposition. This is, remember, opposition to their own cheaper, more comprehensive, more secure health care. It is akin to Tom Franks description in What's the Matter with Kansas? of the image of unemployed and low-wage workers, storming through the gates of an executive's mansion carrying signs, "we want to lower your taxes!"

As Senator Kennedy knew from his brothers' tragic deaths, logic and facts and even measured discourse are of no value to calm those fears. Controversy over the facts behind John F. Kennedy's assassination have obscured the venomous hatred toward the President that existed that very day in Dallas and other cities primarily across the South. Back then, they were the Birchers; today, the Birthers. Back then, putting fluoride in the drinking water to prevent tooth decay was a Communist plot; today, it is government death panels to pull the plug on granny. Members of Congress, among whom courage is such a rare commodity that John F. Kennedy's book documenting the occasional instances won a Pulitzer prize, and ever mindful of their own re-elections, have bowed before the onslaught.

To win passage of health care reform, then, requires eliminating the emotional basis for opposition: the perception of federal 'control.' To do so, I think Senator Kennedy would have sought a way to minimize the federal role, while creating a force-field that achieved the same goal: writing a public plan into the bill, but allowing each state the power to decide whether it wants to include it as part of the mix of insurance plans allowed in that state.

He would have made this compromise because it would have preserved his principles, but yielded the same ultimate result -- lower insurance costs -- as a federal mandate, but would have provided the political space for colleagues at least to vote for cloture. Republicans, with the possible exception of Olympia Snowe, will not come on board, but what is needed is the entire Democratic caucus to vote for cloture. States that adopted the public plan would have lower costs because of the public option. States that decided not to offer the public plan would find that insurance companies would modulate their fees so as not to "invite" in the public plan and, if they did not, politicians would run for office pledging to do so citing not experts but rather actual experience of neighboring "adopter" states. States that allowed the public plan, and thus faced lower health care costs, would become more attractive to businesses.

Although this compromise arose as a political strategy, it also makes excellent policy sense. No one really knows exactly how reform will affect premiums, choice and health outcomes so that comparing the adopter and non-adopter states will provide a laboratory to determine what works best.

This is far superior to the alternative compromise being bandied about that the public plan only exist when triggered by private insurance companies' failure to meet certain standards. That idea does not permit us to take advantage of federalism and have real experience with it in the adopter states, and is an open invitation for years of insurance company diatribe and lobbying to remove the trigger. Senator Kennedy would have seen through that ploy in a nanosecond. By contrast, in the compromise proposed in this article, some states will have adopted the public plan and actual experience will trump theoretical fears.

The 'trigger' idea also does not remove, but just delays, the imposition of a federal mandate, and thus does not eliminate the emotional foundation for fear and loathing that has been stirred by the right wing.

Although one bristles at the thought of compromise because of lies, hatred and stupidity, this President faces unique challenges. Barack Obama is not just the first black man to be President of the United States, he is the first person of color, ever, to govern any nation with a white majority. For some, voting for a black man was one thing -- having him exercise the authority of the Presidency rankles on quite a different level. Couple that with the mess he inherited from the disastrous Bush Presidency that compelled federal intervention on a massive scale -- and many now actually believe that the federal bailouts were started by President Obama -- and there is fertile soil for the lies and innuendo planted by right wing zealots to take root.

Promote the states as the final arbiters of whether to adopt the public plan, and instantly, it is not Barack Obama but 50 state governors and legislatures who wield the power. This is not to suggest that the scurrilous accusations will not continue -- but rather that there is a very simple retort, that "it's up to your State," that provides emotional relief. Indeed, positively promoting federalism as an excellent policy choice increases the President's political capital.

The mess the disastrous Bush Presidency left Barack Obama has limited his policy choices in many areas. For example, President Obama would like to dedicate himself to balancing the federal budget and eliminating debt. He was prepared to make difficult choices, and to raise taxes on the top bracket to help achieve it. Bush, however, left Obama an enormous deficit, rising national debt and the need to boost spending to prevent a monumental economic collapse that would make the debt even worse, and hobble the country for a decade or more. Thus, this man, who temperamentally is more at home with caution, has been forced to champion deficits as the least bad of several unpalatable alternatives.

Most of the policy areas requiring transformation require federal action; indeed, energy independence/climate change requires international action and coordination. Everything the President tries will be attacked as federal overreach by the vested interests. He cannot even urge school children to work hard and remain in school without being attacked for indoctrination.

Thus, when he has an opportunity to promote federalism, when state choice is actually a good policy as well as good politics, the President ought to take it. He will need that political capital for other fights.

Health care reform is such an opportunity. He can reign in costs and achieve universal coverage by providing a public plan, but also foster federalism by allowing each state to determine if it wants to include that plan in the mix of insurance plans offered in that state. The force field created will achieve the desired result without a federal mandate to accept the public plan.

I believe Ted Kennedy would have seized that opportunity. Let us hope his political heir, to whom he passed the torch, will do so too.

Comments

[kylennblack]

It's a good idea but I doubt Teddy would have gone for it.

He'd be worried about the people who get left behind in the states that don't adopt it and he'd consider it unacceptable. Imagine what would happen if states could opt out of Medicare or Social Security.

[WorkingClass]

"To win passage of health care reform, then, requires eliminating the emotional basis for opposition"

Wrong. To win passage of health care reform requires the final and utter destruction of the criminal health insurance companies and their whores in congress.

[CTtransplant]

No more negotiating with the Republicans and Blue Dogs!

I'm getting more than a bit tired of our representatives in Congress who say they don't need to read the bill, they won't sign it regardless of what's in it, etc., etc., etc. These guys make me mad! They are in effect saying to the voters 'we will not do our job'!

We all have - or know of – health care horror stories...­things that should not have been allowed to happen.

Well, Our elected officials in Congress receive health care mostly paid for by us tax payers, yet many are trying to make it impossible for us to have an affordable plan of our own :

While many of us are struggling to afford medical insurance/medical bills.
While Congress people try to stop healthcare reform.
While Congress people accept large contributions from lobbyists to prevent health care reform.

Please sign these petitions - and by all means, spread the word! Thank you!
http://www.petitiononline.com/PubOp676/petition.html
http://action.firedoglake.com/page/s/keepthepledge?source=email&subsource=fwd
http://salsa.wiredforchange.com/o/5649/t/4951/content.jsp?content_KEY=2793&tag=pod_auto-email1

[WorkingClass]

No more negotiating with the Republicans and Blue Dogs!

Agreed. The rightards have emotional and psychological issues to be sure. So let them live. But for their own good and for the good of the country, push them aside and proceed to do whats right. You don't (hopefully) allow your two year old to make your decisions.

[USMAMule]

An excellent article - with a real and very practical compromise on a public insurance option. I like it because it actually postulates a real policy proposal - as opposed to just more bleating about the lies and fear-mongering.

What do we think the chance of a proposal like this coming out of the White House are? I wager slim and none - because I sense full Democratic knee jerk retreat mode that is the instinct of even Democratic Presidents - no matter HOW much the public is actually behind them. Well that and Rahm Emanuel's corporatist middle ground "compromise" needs.

[NationalTreasure]

interesting idea but nothing Teddy would have conceded -- as this would only over burden the states that accepted reform, and leave them with an influx of individuals from states that refused reform -- we already have a huge disparity in statewide insurance standards, this would only exacerbate the problems

[Paul Abrams - Huffpost Blogger]

No burden whatsoever to the states...a­ll done at federal level as currently proposed with the exception that states get to chooose whether to include it.
States that elect not to choose it will be the ones with the increased burdens.

[nyscof]

It's a shame that fluoridation got mixed up with such political silliness.

Actually, modern science indicates that ingesting fluoride does not reduce tooth decay as it was believed to do when fluoridation began. And studies show that ingesting fluoride has many adverse health effects See http://www.FluorideAction.Net/health

People need to get active and demand their legislators to stop the unnecessary, harmful and costly addition of fluoride chemicals into the water supply.

Fluoridation 101
http://www.orgsites.com/ny/nyscof

[GianRico]

Mr Abrams article is the most cogent analysis of a complex problem. He offers a reasonable possible solution and a realistic compromise. It may satisfy the "public option" demands of the Progressives and allay the fears of the 'Blue Dogs'. Maybe one or two GOP may get on board. The leadership must come from Obama. He should make this article available to all Dems and to the President. Let's hope that some inspiration can come from the memory and example of the outstanding legislator Senator Kennedy.

[HMDMSR]

This article is not an analysis as much as it is a suggestion that Congress should tank the public option. No, it won't satisfy progressives. No, it isn't a good idea. Federalism is superior to governance by 50 fiefdoms. Competition between states, in whatever form, is a horrible idea. Federalism is more effective in all areas. Think about how inefficient it is to have 50 different state police agencies, parks, toll roads, and bureaucracies.

For progressives, if there is no public option, there should be a presidential veto. As far as the President is concerned--he has all my sympathy, but I didn't vote for him to be reelected in 2012. I voted for him to be the President from Jan, 2009 to Jan 2012. If it fails now, the battle for national health insurance will be fought again, as will other forms of economic redistribution. Many, before WWII, predicted the economy would fail to provide Americans with healthy, fulfilling lives. They were right--it just took 50 years to happen.

[Paul Abrams - Huffpost Blogger]

I am sorry you read it that way. The article did NOT call for 50 different plans, but rather one plan that 50 different states could adopt, or not. As pointed out in the article, that provision will serve 2 purposes: as forcefield for insurance companies to provide affordable insurance or there will be growing pressure for a non-adopter state to include it; and, to let it play itself out so real data, as opposed to speculative argument, will be able to guide future policy decisions. Allowing the perfect to be the enemy of the good is a recipe for bad.

[JamesinDentonTX]

I'm still doubtful any Republicans will ever vote for anything that will help this administration.

[JamesinDentonTX]

This is the best compromise idea for the public option I have heard yet. I live in Texs though, so we would probably be last to adopt it.