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Ted Kennedy and Health Care Reform

Ted Kennedy attends a health care hearing with First Lady Hillary Clinton

Ted Kennedy attends a health care hearing with First Lady Hillary Clinton

Walking toward the Edward M. Kennedy Institute for the United States Senate, on Columbia Point in Boston, a visitor might notice a neat, modest building housing the Geiger Gibson Community Health Center. Named for two Tufts University doctors who developed the concept of neighborhood-based medical care for low-income residents, the center was conceived at a 1965 policy dinner held by Senator Kennedy. Kennedy visited the center the following year, 50 years ago this month, launching his career-long commitment in the Senate to improving the nation’s health care system. He was impressed by the success of the center in its ability to fill important community needs, and soon introduced and guided legislation resulting in the funding of similar community health centers across the country. 

The origins of Kennedy’s interest in health care can be traced back to family experiences earlier in his life. Teddy’s eldest sister, Rosemary, had special needs, diagnosed in the 1920s with what at that time was labeled “mental retardation.” John F. Kennedy battled chronic medical conditions his entire life and, his father, Joseph Kennedy, Sr., spent the last eight years of his life wheelchair-bound, unable to speak intelligibly after suffering a stroke in 1961. The Senator learned at an early age the importance of receiving quality health care, a point that was undoubtedly reinforced after he broke his back in a 1964 plane crash during his first Senate term.

During six months of convalescence and recuperation, Kennedy recognized that he enjoyed certain advantages unavailable to less fortunate Americans. He witnessed first-hand the unfairness of the health insurance system while his son, Teddy Jr., endured arduous treatment for bone cancer in the early 1970s. Kennedy learned that the parents of other children in similar situations could not afford the same level of successful treatment that his son received.

Fighting for disadvantaged groups who lacked access to quality health care quickly moved to a prominent place on the Senator’s legislative agenda. When Democrats held power in Washington, Kennedy seized the initiative, passing a host of landmark legislation, including COBRA (giving workers access to group health benefits after a change in job status), the Ryan White CARE Act (offering treatment to HIV/AIDS patients), HIPPA (protecting patients’ privacy), and SCHIP (providing health insurance for children). 

When Republicans controlled the White House or Congress, Kennedy fought to scale back health care budget cuts proposed by President Reagan and, subsequently, House Speaker Newt Gingrich. Yet Kennedy knew the value of reaching across the aisle to work with Republicans, such as Senators Nancy Kassebaum (R-KS), Orrin Hatch (R-UT), and John McCain (R-AZ), on major pieces of health care legislation. 

Kennedy’s battle to reform what he saw as a broken and unfair system led him back repeatedly to one of the defining issues of his career—universal health care. In the early 1970s, he held private negotiations on the issue with the Nixon White House. Affordable medical care for all Americans became the central theme of his unsuccessful 1980 presidential campaign. In the early 1990s, Kennedy worked closely with President Clinton and the First Lady on national health insurance legislation. Teddy’s collaboration with President Obama on the Patient Protection and Affordable Care Act (PPACA), which passed in 2010, seven months after the Senator’s death, appropriately made it the crowning achievement of his Senate career.

At the White House bill-signing ceremony, attended by the Senator’s widow, Victoria Kennedy, and his son, Congressman Patrick Kennedy, Obama observed, “I remember seeing Ted walk through that door in a summit in this room a year ago, one of his last public appearances, and it was hard for him to make it, but he was confident that we would do the right thing.”

To Kennedy, access to affordable health care was a right, not a privilege. No issue was more important to him than working to ensure that all Americans had access to quality medical treatment. His son Patrick, named for the first of the famous clan to arrive on U.S. shores in the midst of the Irish potato famine, placed a poignant note on his father’s Arlington grave immediately after passage of the PPACA. It read: “Dad, the unfinished business is done.” 

Here are some excerpts from the Miller Center’s Edward M. Kennedy Oral History interviews:

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Phil Caper (Kennedy staffer): [Richard Nixon] had what today looks like a very progressive healthcare package, including national health insurance… Nixon, at that point, was in big trouble. And he was looking for a win, which is one of the things that motivated us to start talking to him and to try to get this, because the administration was very much a part of the negotiations on the Kennedy-Mills [national health insurance] legislation… I think people did think it was inevitable, or at least in 1971, ’72, ’73. I think the first time that we really realized that it wasn’t inevitable is when we lost the vote in the House. It was a committee vote, in the Ways and Means Committee, on the Kennedy-Mills bill. That went down to defeat fairly narrowly in that committee. 

I remember Kennedy was there for the committee vote, was there in the House in the committee room. He went over to watch it, and he came back afterwards and said, “You have no idea how powerful these insurance guys are. They’ve just begun to flex their muscles...” In the end the insurance industry and the lack of dedicated support on the labor side killed it. That’s the closest we’ve come [until PPACA.]

Stuart Eizenstat (adviser to President Carter): This debate [over national health insurance], in the context of a potential, looming Kennedy challenge, happened as Carter’s popularity was dropping. Polls were showing that Kennedy would win the nomination if he ran. I argued with the political people—with Hamilton and Jody and Gerry Rafshoon and others—that the best way to forestall a Kennedy challenge was to agree with him on health insurance, because if we did, there would be no rationale for his running. This was the big enchilada. Many of the other issues were—mixing metaphors—icing on the cake, but the cake was national health insurance. That was the core. That was the big social program. That was the issue that the party stood for and that the liberal wing wanted… 

I’m convinced that when the negotiation failed, that convinced Kennedy that he should run and had to run. It wasn’t long afterward that he did. No one can prove it, but it would have been difficult for him if we had reached an agreement. What rationale would he have had to run if we were working together on this program..? I would posit that with all the difficulties we had—the hostage crisis that came later, with inflation, with high interest rates—that it was the Kennedy challenge, splitting the party, that was certainly a significant factor, if not the central ingredient in all of this. It wasn’t the single ingredient; there were the external circumstances—but it was debilitating, it was divisive, and it certainly was a factor in electing [Ronald] Reagan.

Anthony Fauci (leading AIDS researcher): The Kennedy connection is that Ted had always been very open-minded about gay men, about people who were disenfranchised, any people who didn’t have good health coverage, whether you were an injection drug user, or whatever. It was very clear that he was very empathetic towards people in need. And that’s the reason why I think, early on, he rose as the champion of helping us in so many different ways… The fact that Kennedy was out there pushing that concept [expanding clinical trials] made it much easier for me, during a more conservative administration, to do it. I think that was the beginning of a very special relationship with Kennedy, because I don’t think anybody would screw around with me if he was very favorably disposed to the things that I was trying to do.

Janet Heininger: Was it interests that killed it [universal health care] under Clinton?

David Blumenthal (Kennedy staffer): I take a different view. I know that there are people who think that it was either the HIAA, Harry and Louise, or Clinton’s incompetence, all of which were important. But as I look at—and I’m not a political scientist—but as I look back at the forces you need to change something as massive and as complicated and as politically fraught as healthcare, I think you need a constituency that favors it. I mean, you can’t get something through our legislative process unless someone’s lobbying for it, and who was lobbying for it.

Caper: I think one of the biggest mistakes that Clinton made was to come up with something that was so damn complicated nobody could explain it, and nobody could understand it. I mean, that’s a recipe for legislative gridlock automatically. And the fact that they didn’t understand that was astounding to me. Then the process they went through with all the secrecy and all the—it heightens everybody’s paranoia. It was just mishandled. 

Sheila Burke (chief of staff to Robert Dole): Any solution [on universal health care] that didn’t involve the financing committees was not likely to be a realistic one. There was no great love between many of the Finance Committee Democrats and Kennedy, and certainly not with the Republicans on the Finance Committee at the time. Even with the Democrats, there was tension, and certainly on the House side…

Heininger: What were the principles that you saw in him that undergirded his approach to health care?
Burke: Equity, that there was an inherent unfairness in the system, that he should help people who could not otherwise fight for themselves. I think Kennedy thought that the government should help solve problems that people couldn’t otherwise solve and that it should always support those who were least capable of solving their problems. I always had a sense that it was about the unfairness in the system… The coverage of children, the disabled, the engagements were all about those least capable of caring for themselves. I had a sense that Kennedy as a person of extraordinary wealth and extraordinary gifts felt the obligation to care for those least cared for.

Written by Rob Martin, Research Director for the Miller Center's Edward M. Kennedy Oral History Project.

Date edited: 08/23/2016 (4:08PM)


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