I can’t remember a time in my life when the subject of health care wasn’t a hot potato. And I’ve had the dubious distinction of having arrived as a consumer in the health care marketplace as it transitioned from an expectation of the common working person to an increasingly luxurious extravagance of the privileged, Obamacare notwithstanding. I had a ringside seat to this generational shift. I have never been without healthcare; some classmates of my younger two children, however, haven’t had it since they aged out of their parents’ households.
It came with the job, so to speak, in every position I’ve held for 40 years; my kids, however, have yet to be offered any such benefit. It’s still out there, but not nearly as prevalent as it once was.
I was unaware, as a teenager in the mid-Seventies, that Jimmy Carter was doing his damnedest to fix this while he was president. Or that Ted Kennedy, who considered the implementation of a true national health care program to be his life’s work, torpedoed it.
Oddly, the two men were in virtual lockstep, when it came to their values and hopes for the nation. In Kai Bird’s book The Outlier, Carter is quoted as saying that there were “no philosophical differences between me and the senator.” And when comparing their views on policy, that rapidly becomes clear.
All the same, the two were rivals – bitter rivals. Kennedy was a legislative juggernaut, holding tremendous power on Capitol Hill and with public groups having liberal/progressive agendas. And after blowing an opportunity to advance the cause of national health care in cooperation with Richard Nixon’s White House in 1973, Kennedy was prepared to leverage his power to the hilt to move the needle.
Carter was just as passionate about the cause. Addressing it meaningfully had been a key promise in his 1976 presidential campaign: “We have an abominable system in this country for the delivery of healthcare, with gross inequities toward the poor – particularly the working poor – and profiteering by many hospitals.” At that time in the US, 28 million people had only minimal coverage, and 26 million had no coverage at all, according to Bird’s book.
It seems like an obvious one-two punch – a liberal president and a get-things-done liberal senator – to push through ground-breaking legislation that implemented a true national health care program that filled in the vast gaps in the system.
But it didn’t happen, for two reasons.
The first was a matter of personality. Carter, though viewed within Washington as an outsider, was in fact a brilliant man and a practiced pragmatist, owing to his success as a businessman and his years in the military. He understood that, even with a Democratic House and Senate, concerns over the economy would make votes for a hugely expensive new federal program hard to come by. There would be great push-back from business, which would be required to adhere to new regulations and implement benefit offerings for employees mandated by the program. Put simply, Carter felt the only way to get the legislation through was incrementally – in phases, each unfolding as the federal budget allowed. A pragmatic, years-long rollout.
Kennedy was having none of that. With labor staunchly behind him, he pushed Carter aggressively for a single piece of legislation that would create a comprehensive single-payer universal health care program. Put another way, he didn’t give a damn about working with private insurers – they could all go to hell, as far as he was concerned - and didn’t care what it cost. He wanted a big bang - “bold leadership and swift action build around a single piece of legislation” - and that was certainly in keeping with his aggressive, dominant personality.
Carter worked for two years to win Kennedy over to his practical approach; Kennedy came up with his own bill, and sought the president’s endorsement of it.
To the credit of both, these two visions for universal health care each contained powerful innovations. Carter’s version provided for free health care for children and pregnant mothers, and a special provision for “catastrophic” health crises (such as dealing with serious cancer or heart surgery, etc.), capping family payout at $2,500 annually, with the federal government picking up the rest. Kennedy’s version featured Obamacare-styled offerings people could pick from, with premiums scaled to income, and prescription drug coverage in Medicare.
Their differences were more tactical than substantive. Kennedy didn’t think incrementalism had any support among voters: “I don’t think you can go to an elderly group and say... if hospitals keep their costs down and the economy doesn’t go so much into a deficit, then you might be phased in,” he said in a 1978 phone call with Carter, according to Bird.
Carter was certain – and his advisors bore him out – that Kennedy’s approach would mean doom in Congress. The big bang approach would fail; such a bill would never be passed. He feared the Kennedy program could cost as much as $100 billion (his own program would have cost less than a third as much), and at that cost, it wouldn’t get the votes needed.
On the other hand, he couldn’t get his own version through Congress without Kennedy’s endorsement. “It will doom health care if we split,” he told Kennedy. “I have no other place to turn if I can’t turn to you. I would like to leave office with a comprehensive bill in place, but I must emphasize fiscal responsibility if we are to have a chance.”
And now we come to the other reason it all came apart.
Carter mistrusted Kennedy, and with good reason. The latter saw himself as the Democrat heir-apparent, inevitably a White House occupant, and was in Carter’s view “an impatiently ambitious man.” But it was a 35-year-old Joe Biden, a first-term senator from Delaware, who first spoke the words out loud to him: “Ted Kennedy is running for president in 1980 and is already lining up support.”
The audaciousness of challenging a sitting president from within his own party was shocking enough; to leverage legislation that addressed a growing national crisis in pursuit of such an ambition was jaw-dropping. Carter, however, would not back down; he knew that Kennedy’s program would never win. And he knew that his own program couldn’t succeed without the support of Kennedy and the unions that backed him.
It all came to a head later in 1978 in a meeting in the Cabinet Room at the White House, between the two men and their major advisors, when Carter said openly that he was going to proceed with submitting his own legislation. At that point, per Bird, Carter domestic policy advisor Stuart Eizenstat leaned over to his colleague Joseph Onek, who had done a lot of the detail work on the plan, and whispered, “This is the beginning of Kennedy’s presidential campaign.”
Kennedy protested that Carter’s plan was too little, too late, but gave lip service to studying the plan more thoroughly – asking Carter to delay announcement of the proposed legislation until he could do so. Carter agreed.
A few hours later, Kennedy went public in a press conference, blasting Carter’s proposal before he had even presented it. Carter considered this a betrayal of the highest order.
Predictably, Kennedy’s legislation went nowhere. And that defeat weakened Carter’s own prospects even further – in turn weakening his bid for re-election. Kennedy did challenge him for the nomination, and that challenge likewise went nowhere, accomplishing nothing other than boosting Ronald Reagan into the Oval Office.
The episode left Carter bitter.
“The fact is that we would have had comprehensive health care now, had it not been for Ted Kennedy’s deliberately blocking the legislation that I proposed,” he told Leslie Stahl in 2010. “It was his fault. Ted Kennedy killed the bill. He did not want to see me have a major success in that realm.”
“In effect, he insisted on his own plan or nothing at all,” he once wrote. We, the US, got nothing at all – until Obamacare, 30 years on, which a dying Ted Kennedy remorsefully supported.
In the intervening years, Kennedy openly confessed that his failure to work cooperatively with both Nixon and Carter was his “greatest regret” - a regret that stands out in an otherwise distinguished career as a legislative juggernaut, introducing No Child Left Behind, HIPAA, the Family Opportunity Act, the Americans with Disabilities Act, S-CHIP – more than 300 bills altogether.
Kennedy wanted the win for himself. He wanted universal health care, a cause in which he was legitimately and earnestly invested, to be his red carpet to power. He couldn’t bring himself to let it be Carter’s win – it needed to be his. And the price he paid – the price the nation paid – for this horrible misstep was dear.
My grandson has now also come of age, is planning his professional life, and doesn’t factor health care into his expectations at all. Part of it is that he’s nowhere close to thinking about marrying and raising a family (his generation doesn’t seem much interested in such things), but I worry that the bigger part of it is he has sensed there is little security in any program that offers him this essential service.
How much of that is on my generation? My parents’ generation? It certainly isn’t the doing of Gen X or the Millennials. It’s easy to blame Ted Kennedy, and it’s easy to despise the Republicans who demonize Barack Obama for finally doing something. But the uncomfortable truth is that there is still much to do.
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