Kennedy's 40 Year Push for Universal Coverage

When Senator Ted Kennedy files a highly anticipated bill that would make sure all Americans have health insurance he'll try to cap a campaign that began, for him, in 1969. David Blumenthal worked for the Senator 30 years ago and is still an advisor.

"For the last 40 years, Ted Kennedy has, almost singlehandedly, kept the idea of universal access to health care services alive."

Kennedy has filed a bill that would expand coverage in almost every session of the Senate. While the goal has not changed his approach has shifted over the years.

(fade up Rolling Stones)
It’s the summer of 1965. The Rolling Stones have the country’s top hit. Lyndon Baines Johnson signs a bill that, for the first time, guarantees health care for low income and older Americans.

LYNDON BAINES JOHNSON: No longer will older Americans be denied the miracles of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over the lifetime.

And a young Senator Edward Kennedy visits a new two room clinic in South Boston that will become a national model.

JACK GEIGER: What he did with Community Health Centers was to create a new kind of institution for the people most in need.

Clinic co-founder Jack Geiger walked Senator Kennedy through the small center in what was the Columbia Point housing project that hot August day…explaining that residents would have easy access to preventive care focused on their needs.

GEIGER: He was very taken. Either that night or maybe a week later, he called and in conversation, worked out the proposal that he was going to introduce legislatively.

It was Kennedy’s first health bill. The current Health Centers Renewal Act includes $2.1 billion and covers 18 million patients at clinics that have become institutions across the country. The roots of Kennedy’s quest for health care for everyone are deeply personal.

TED KENNEDY: There probably has not been, a family in this country that has been touched by sickness, illness and disease, like my own family.

Kennedy described his father’s stroke, his own 7 months of rehabilitation for a broken back and his oldest son’s cancer treatment before a national gathering of Democrats in 1978.

KENNEDY: We were able to get the very best in terms of health care, because we were able to afford it. It would have bankrupted any average family in this nation. As long as I have a voice in the United States Senate, it’s going to be for that Democratic platform plank that provides decent quality health care, (cross fade here to speech at DNC) North and South, East and West young, old, will have decent quality health care as a fundamental right and not a privilege.

From that meeting in 1978 to the Democratic National Convention in 2008…word for word…Kennedy repeats his promise to achieve what he calls the cause of his life. But he would see three near agreements slip through his fingers.

It’s 1969...four years after the creation of Medicare. Kennedy files his first attempt to create national health insurance.

STAN JONES: Medicare was thought of as the first step. It was intended from the get go that it would cover the whole country. Kennedy shouldered that mantel to finish that job.

Stan Jones, the aide Kennedy hired to work on national health insurance, says there was a lot of momentum for a Medicare for All type bill; but Congress had concerns.

JONES: Medicare was exceeding everybody’s cost projections. Strategically it was a bad idea to start with the elderly. They were in terrible need of help, but they’re the most costly population. We’d go down to talk to people on the Finance committee or the Ways and Means committee and the first issue was, but my god, look what’s happening.

So Kennedy, in what would become characteristic fashion, looked for a compromise. He launched secret negotiations with the two men he’d need to pass a national health coverage plan.…House Ways and Means chairman Wilbur Mills and President Richard Nixon. A compromise between Kennedy and Mills sparked union outrage and ended in flames. President Nixon proposed requiring that employers provide health coverage…an approach no Republican would touch today. Nixon’s aide, Stuart Altman and Jones from Kennedy’s office traveled to the mountains of New Mexico, away from the glare of the nation’s capital, to look for common ground.

STUART ALTMAN: We even went on one of these gondola rides up to the top of mountain; and by the time we got to the top we were convinced we had exactly the right compromise. Maybe it was the rarified air of 8,000 feet.

Secret meetings continued in a church basement through the summer of 1974. Kennedy never agreed to the employer mandate although he later adopted this approach. Mills and Nixon tried to push through a bill…but political coalitions were unraveling along with the political careers Kennedy’s two, once powerful, partners.

Richard Nixon: I have never been a quitter. But as President, I must the interests of America first.
WILBUR MILLS: I apologize again tonight for what happened. I was wrong in ever taking one glass for champagne.

Richard Nixon resigned the same day his compromise with Mills was scheduled for a committee vote. A few months later Mills had that glass of champagne, was caught with stripper Fanne Foxe and faded from power. Unions called Kennedy a sellout and a near agreement on national health reform crumbled. Again, Stuart Altman.

ALTMAN: It set in motion my view about a) the importance of leadership, and b) every one of the major lobbying groups supported health care reform, but when they faced the possibility of a plan they didn’t like as well as their own, they worked to kill any compromise.

In 1974, health care was 8% of the nation’s economy. This year it’s expected to reach almost 17%. To Stan Jones that means there’s an even greater threat that some special interest group won’t get what it wants and will turn the public against a health care bill.

JONES: The way we pay for health care has so confused the average person that they are not in position to make a good judgment. So I have been telling folks new to Washington that the only way this issue is going to get serious attention is if some citizens lobby, perhaps Obama’s network can be educated so they know where their interests are and then make them better know in Washington ‘cause they don’t have a prayer against the well funded system.

The defeat of 1974 demoralized many supporters of a national health program. But Kennedy rebounded arguing that rising costs, uneven quality and gaps in health coverage could not be ignored.

KENNEDY: That is why national health insurance is the great unfinished business of the Democratic Party.

It’s 1978. Kennedy presses Democrats and a reluctant President Jimmy Carter to make national health insurance a top priority.

KENNEDY: Our party gave social security to the nation in the 1930s, we gave Medicare to the nation in the 1960s and we can bring national health insurance to the nation in the 1970s.

Kennedy files a bill written with the help of Rashi Fein on the Committee for National Health Insurance. It goes much further than anything President Carter wants to consider.

RASHI FEIN: The President had a set of constraints, there had to be a role for health insurance companies, so this was not going to be Medicare for All. There was much friction in and around how quickly. Kennedy wanted a time table. The President wanted to say, let’s take a first step and see how it goes.

JILL QUADAGNO: But behind the scenes, even though their proposals were very different, Carter and Kennedy actually did negotiate a compromise plan that might have worked.

Jill Quadagno is the author of “One Nation Uninsured: Why the US has no National Health Insurance.”

QUADAGNO: That was 79, but then events just blew that off the table.

Quadagno says Carter suspected that Secretary Joseph Califano was sneaking around to support Kennedy and fired him. The economy faltered, an anti-government movement was brewing and an angry mob took employees at the American embassy in Teheran hostage. Tensions between Carter and Kennedy errupt over health care. Kennedy challenges Carter in the 1980 primary…a fight that splits the Democratic party. David Blumenthal, who worked for Kennedy during this period, has just finished a book on the history of Presidents and health policy.

DAVID BLUMENTHAL: One might argue that the conflict between Kennedy and Carter over health insurance was the swan song of the liberal Democratic period that peaked with Lyndon Johnson. It became impractical and has remained impractical for the subsequent 25-30 years to do the kinds of things that Kennedy wanted to do in 1969.

Now it’s the early 1980s. Kennedy regroups. His top health care aide David Nexon remembers one of the Senator’s favorite stories during this period. A guy is third in line...to interview for a job as a geography teacher. He sees one candidate lose the job because he says the world is round…and the next bec he says the world is flat. The third guy gets the job.

DAVID NEXON: They asked me if I thought the world was round or flat and I said I could teach it round or I could teach it flat (laughs). You know the Senator is always interested in finding different ways to get to the same goal, which is really to get everybody covered with quality, affordable health care.

Kennedy focuses on incremental steps: health insurance for the unemployed and COBRA, the program that lets Americans keep their health insurance when they leave a job as long as they pay for it. Rashi Fein and others who worked closely with Kennedy on national health insurance now find themselves testifying in opposition to the Senator. Fein remembers a hearing on one of Kennedy’s incremental bills.

FEIN: During the testimony, he turned to the audience and said, there are those who would argue that a universal comprehensive system is really the best approach, and I would not deny that. But that’s not where we are politically and I will not hold hostage those people who can be helped today because I want to argue for something bigger and better but which they can’t have and wouldn’t help them now.

Then in 1985, Kennedy noticed that although the recession is ending, the numbered of uninsured Americans is rising and he sees a way to revive the universal health care debate. Kennedy filed a bill based on the private insurance system that includes an employer mandate. Nexon says fit the political climate.

NEXON: It would have picked up about 80% of the uninsured. It was the first bill in history I think ever reported out of any committee in Congress that would have actually covered most Americans.

In the late 80s and early 90s, momentum is building, again, for universal health coverage. By 1993, President Bill Clinton makes passing national health care reform a top priority for his first year.

PRESIDENT CLINTON: Let me say this again, I feel so strongly about this. All of our efforts to strengthen the economy will fail unless we also take bold steps to strengthen our health care system.

Nexon and other Kennedy aides worked closely with Clinton’s health care task force. But other key lawmakers, notably Senate Finance committee chairman Patrick Moynihan do not support Clinton’s health care bill and it never receives serious consideration in the Congress. Nexon says Clinton had early setbacks that cost him politically and delayed filing of his health care bill.

NEXON: Clinton came in you remember it was the economy stupid and don’t forget health care. So the first thing out of the box was this stimulus package which didn’t do very well. Then he had the big economic package, the Deficit Reduction Act. And his whole Treasury team was saying you can’t put health care out there 'til you pass the economic package because it looks incongruous. Then the economic package took longer than anyone expected and barely passed the Senate.

By the time the health care bill came out, various groups that had been neutral shifted to opposing major health care reform. Republicans decided that blocking Clinton on health care would help them regain control of the House.

AD: This was covered under our old plan, yeah that was a good one. Things are changing and not all for the better

And the Harry and Louise ads stoked public fears about change.

AD continues: If we let the government choose, we lose.

Harry and Louise illustrate one of three common mistakes that make supporters of health overly optimistic…says Jacob Hacker, an expert on the US political history of health insurance reform at UC Berkeley.

First they underestimate that many Americans are fearful of the federal government and fearful that changes in the system will make things worse.
The second problem that reformers underestimate is that interest groups that say they want to deal up front often become opponents.
And third, people who say President Barack Obama has several years to work out the details have not looked at history. The window of opportunity is open for a very short time. He really needs to put in place the key features of his reform proposal/preferably in the first half of the first year if he’s going to have the success that he hopes.

Others disagree about how quickly Obama must push a health care bill. In the late 1990s, Kennedy rebounded again with a children’s health insurance program. In 2006, he was instrumental in passing, and securing money for the Massachusetts health coverage law. Now, he's fighting to pass a similar plan for the country. Aides say Kennedy is optimistic and willing to do what it will take to finish the job.