This originally appeared at Newsweek.com.
It must pain those fond of Senator Ted Kennedy that his death comes just when the current health-reform effort is threatened by the same kind of attacks that tanked previous efforts. In fact, the Obama health-reform package Kennedy supported in his last days is similar to one Kennedy helped defeat when proposed by President Richard Nixon. If anything, the Obama plan is more conservative. Nixon would have mandated that all employers offer coverage to their employees, while creating a subsidized government insurance program for all Americans that employer coverage did not reach. It would take a miracle to pass such a plan today—a public insurance plan and an employer mandate are two provisions of the proposals now in Congress that are most in doubt.
But Kennedy helped kill Nixon’s proposal not only because he preferred a government insurance option for everyone, but because he believed it was politically achievable. Medicare, the government program for the elderly, was then only nine years old, enacted as part of President Lyndon Johnson’s campaign to expand the social safety net. Liberals hoped this would be a first step toward a national health-insurance program that the next Democratic president could enact. That victory seemed around the corner—Nixon proposed his plan in 1974, while embattled in the Watergate scandal.
President Jimmy Carter did not make health reform a priority, however, and Kennedy later regretted rejecting Nixon’s proposal. “It was a rare moment in his Senate career where he made a fundamental miscalculation about what was politically possible—a lot of liberals did,” says Yale University political scientist and progressive health-reform advocate Jacob Hacker. “What was not recognized by anyone at the time was that this was the end of the New Deal era. What would soon come crashing over them was the tax revolts” that ushered in Ronald Reagan and a conservative, antigovernment philosophy.
Kennedy’s approach to health reform showed his temperament as a legislator, perhaps morethan any other issue. He was an idealist, but one who took a long-term,pragmatic approach. He was devoted to his goals, but not locked intoany one way of achieving them. Rather than giving up on health reform or digging in his heels on a government-insurance approach, Kennedy later embraced a Nixon-style employer-based model. In fact, when he cosponsored another unsuccessful reform effort called Health America in 1991 that combined an employer mandate with a new public program, Princeton University health economist Uwe Reinhardt reportedly asked one of Kennedy’s aides if they intended to cite Richard Nixon in a footnote.
Kennedy may have always preferred the government insurance approach, and he introduced legislation called “Medicare for All” as recently as 2006, perhaps trying to push the envelope when a Democratic resurgence was creating a new opening for progressive legislation. But this didn’t stop him from enthusiastically championing the employer-based approach put forward by Barack Obama when he became the party’s leader.
Jonathan Oberlander, a professor of political science at the University of North Carolina and author of The Political Life of Medicare, says this distinguished Kennedy from many other health-care advocates on the left who were dogmatic about their support for a single-payer approach. “I think he was a true ideologue—and I mean that in a positive way—a true liberal in a Great Society/New Deal sense who wanted to expand the safety net for the disadvantaged,” Oberlander said. But Kennedy “also understood that in American politics, rarely do you get what you want, so he was a supreme pragmatist … and his willingness to accept an employer-based system is a sign that his true goal was to get to universal coverage” regardless of the program’s structure.
Kennedy was also willing to take small health-care victories when he could, joining with Republicans Sen. Orrin Hatch to enact the Children’s Health Insurance Program and former senator Nancy Kassebaum to pass legislation to extend employer coverage to workers after they leave their jobs.
It may be ironic that Kennedy is famed for being a liberal stalwart, but his accomplishments came not from unyielding dogmatism but from an ability to eke out partial victories when he judged whole ones were out of reach. And he never stopped trying to finish the job—by his own count, he mounted 15 separate efforts to enact universal coverage.
With Kennedy’s passing, his colleagues now must decide whether now is the time to get it done.