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Recalling Kennedy: Health Care Players Reflect on His Career

Aug 26, 2009

Sen. Edward M. Kennedy knew the rhythms and rules of Congress better than most of his colleagues. While his public persona was one of a raging liberal, the Massachusetts Democrat was a pragmatic lawmaker who created alliances with Republicans to pass major legislation helping people with AIDS, creating a new health care program for children and barring discrimination against people with disabilities.

In mourning his death, political allies and adversaries alike praised Kennedy's work ethic and personal touch.  While he came from enormous wealth, he spent his career working to help the poor, and secured the first funding for what is now a nationwide network of community health centers. "The country has lost an incredible advocate for people who never had a lawyer or a lobbyist to stand up for them. said Sen. Christopher Dodd, D-Conn. "They always had Ted Kennedy."

--Mary Agnes Carey


Robert Blendon, professor of health policy and political analysis, Harvard School of Public Health

He was the single biggest factor behind keeping national health reform on the agenda for years. You couldn’t run as a candidate without knowing he would be there or raise the issue or highlight it in a way that had to be taken seriously by Democratic presidential candidates. And, as far back as Richard Nixon, even Republican candidates.

Nixon took on health reform because he thought Kennedy in 1972 would be the Democratic nominee. He felt he was not going to run against Kennedy and have him effectively use health care in the election without having a plan of his own. Although people in the health field think it’s obvious that presidents will talk about health reform, it has always had political problems for major leaders. Kennedy made it almost impossible for Democrats not to take this issue on.

 

Ross Baker, professor of political science, Rutgers University

Like all successful politicians, Ted Kennedy was a great actor -- I don’t think anyone I know could summon up moral indignation more convincingly than he did. I can remember him getting red in the face, and his jowls shaking, and pointing and gesturing and making some very, very emphatic point to one of the Republicans on the committee, whether it was Orrin Hatch or Jon Kyl. And then he would sit back in his chair with kind of a smug smile on his face, and put his arm around Chuck Grassley. He would make clear that none of it was personal.

But those dramatic moments were the ones that convinced all liberals that he was on their side, and after he’d delivered himself of these great and emotionally laden orations, he would say, “let’s deal.” That’s what made Ted Kennedy such a great senator. And if you talk to the other great Senate deal makers, like Bob Dole… he would tell you the same thing: that after all of the histrionics, this was a man who knew the art of the deal in the United States Senate.

He had the Rosetta Stone of the way things got done in the Senate.  It was something that he had acquired over the years – it was almost a kind of metaphysical understanding… that enabled him to accept what he thought was achievable, and not to go down all flags flying for a principle that was unattainable.

 

Judy Feder, senior fellow, Center for American Progress, and professor of public policy, Georgetown University

My earliest extended period of working with him was when I was staff director of the Pepper Commission in 1989 and 1990 on health and long-term-care reform. He showed up for every meeting. When he beat me to the meeting one morning, much to my embarrassment, he said he carried [punctuality] from his childhood: His father did not tolerate not showing up on time.

It epitomized his overall investment. He was about getting the job done.  He was open to every possible idea. Just let’s get it done.

 

Paul Starr, professor of sociology and public affairs, and Stuart Professor of Communications and Public Affairs, Princeton University

Kennedy was the one who in 1978 pioneered the approach that shaped both Clinton's and Obama's approaches to health care reform.

It was in '78 that he made a proposal, which called for multiple private plans to compete with one another, instead of expanding Medicare. [His proposal] had at that point many of the mechanisms that people had been trying to institute since then, including ideas about the actuarial risk taken on by health insurers.

Kennedy was very flexible on health care and many other issues… He was not an ideological left-winger. It's just not correct. He was much more market-oriented than people understand.

 

Gail Wilensky, senior fellow at Project HOPE, administrator of the Health Care Financing Administration (now Centers for Medicare and Medicaid Services) during the George H.W. Bush administration

His special relationship with Sen. Hatch was in many ways most responsible for Medicare Part D... Without his leading the charge to bring 20 Democratic senators on board, it never would have passed. I was one of a number of analysts who said it would not pass, not because it was not needed but because it was not in the Democrats' political interest to see a new benefit approved by a Republican president and a Republican-controlled Congress... It was a politically courageous move… 

[Sen. Kennedy was a driving force in expanding Medicare to cover prescription drugs for all seniors, but he voted against the final version of the bill over concern about Republican-backed  provisions he thought would undermine the traditional Medicare program.]

One thing that struck me was his saying that he regretted not taking advantage of various opportunities in the past, such as in the Nixon era, to support a flawed reform bill instead of waiting until he had everything he wanted. There was a real sense of regret for not having gone for what was achievable and his not wanting that to happen again.

 

Tom Scully, senior counsel, Alston & Bird; CMS administrator during the George W. Bush administration

Forget any substantive differences we may have had, he was an incredibly nice guy. I would walk through the Capitol and he would always stop to chat, which guys of his stature did not have to do.

His most important achievement is still to come when we get health care improvement and in the long run some form of universal health coverage. It will happen largely because of his many years of hammering home the need for it.

 

Dan Hawkins, senior vice president, National Association of Community Health Centers

For us in the health centers, we call him “The Godfather.” And we kidded him about that one time, and [he said], "Aw! Don't do that in public!” But we said, "No, you're ‘The Godfather.’" He was there at the moment of birth.

 

 

Diane Rowland, executive vice president, Kaiser Family Foundation

His contribution was broader than just providing services to low income or disadvantaged populations. It was really how to improve the overall health of the nation, whether it was through better regulation through the FDA or better improvements in the way we handle immunizations and vaccinations. It was a broad sweep of saying that health care is essential to the way a country takes care of its citizens and improving the health of the American public ought to be a priority. One of the things about Kennedy that you always remember is how he used the hearing process to bring the voices of the American people and their concerns to the Senate. It was a very people-oriented approach to politics.

My husband [who worked for Kennedy] always told me there was a brief case that went home with the senator every night and everything in the brief case had to be two pages long because the senator said if you couldn't tell in two pages what the issue was you didn't understand it enough. That brief case would go home every night and the next day it would come back and there would be personal notes… . He was really a senator who did his homework.

 

Ellis Mottur, former Kennedy staffer and Clinton administration official

To really understand Sen. Kennedy's role in all this, it's important to realize his depth of commitment, which really comes from a whole lifetime. His sister Rosemary was institutionalized after a lobotomy, his three brothers all got killed, his father's stroke, and then of course, his own air crash in 1965. His youngest child… had terrible asthma. He's gone through all of that, and it has had a profound effect on his own personal commitment to the health issue.

 

Sara Rosenbaum, chair, Department of Health Policy and Harold and Jane Hirsh Professor of Health Law and Policy at George Washington University's School of Public Health and Health Services

Right after mental health parity bill passed the Senate, my phone rang as I was driving home. Normally I don't pick up while I'm driving, but that day I did. There was this booming baritone voice. It was Sen. Kennedy, ecstatic about passage and calling to thank me. We spent about 10 minutes talking about how important it was... He had worked so hard on the bill. He was like a kid, one could just hear the delight in his voice. Not a week later, he was diagnosed with brain cancer. And I remember saying to my husband how much I wished that I had a way to preserve the conversation.

 

Stuart Altman, professor at the Brandeis University Heller School for Social Policy and Management

I've known Sen. Kennedy since the early 1970s, when it would look like we were on opposite sides. I was a political appointee in the Nixon administration and he was a young senator and clearly to the left. We used to meet in the basement of a church, St. Marks [Episcopal on Capitol Hill], to see if we could hammer a compromise [on Nixon-era health reform] that would be acceptable to him, and see if the more liberals might support it, and the conservatives.

I learned two things about him. One, he's a man of just tremendous integrity. Two, he really wants to get legislation done that helps people. Even though he's ideologically a stronger liberal force, when he needs to compromise he does it. Boy, we miss him now.

 

Nancy Kassebaum Baker, former Republican senator from Kansas

He didn't speak in a soft voice.....He would go on and on and on and then when you really got down to the nitty gritty he was extremely good at knowing what you could get and how best to get it and work to get what best you could out of the situation....

He came to care a lot about the legislative process and the traditions of the Senate and of Congress and how important it really was to the successful  governance of the country to have the debate, to make the case, to be willing to stick with it.

KHN Staff contributed to this article.

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