Memo to Jimmy Carter: Ted Kennedy Didn't Sabotage Healthcare Reform

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tags: Kennedys, Ted Kennedy

Timothy Stanley is Leverhulme Research Fellow, Royal Holloway College, University of London, and author of Kennedy vs. Carter: The 1980 Battle for the Democratic Party’s Soul (Kansas, 2010).

In an interview on CBS that aired on Sunday, President Jimmy Carter claimed that Senator Edward Kennedy deprived the nation of comprehensive healthcare by sabotaging a bill his administration floated in 1978. The charge is nothing new—Carter made it in his memoirs Keeping Faith thirty years ago.  It has contemporary relevance, though, because Carter implies that U.S. liberals are their own worst enemy.  Kennedy was driven, he said, by a mix of issue militancy and spite:  the senator “did not want to see me have a major success in that realm of life.”  Had Ted Kennedy been less petty and more practical, concludes Carter, we could have comprehensive healthcare by now.  The lesson for latter-day liberals:  shut up and get behind President Obama’s healthcare proposals.

But the story of the failure of the 1978 bill is more complex than that.  Carter should take some of the blame for floating an anemic piece of legislation that, arguably, would have done more harm than good to the cause of healthcare reform.  Kennedy’s opposition was principled and rational, and he wasn’t just speaking for himself.  One interesting difference between then and now is that in the 1970s, the demand for healthcare reform was tied to a genuine mass movement.  Kennedy was just its figurehead and Carter overestimates the senator’s influence.  Liberalism had more political clout back then, and liberals had enough confidence in their ideas to think they would outlive Carter’s moderate administration.  They were wrong, but their miscalculation was understandable.

Throughout the 1970s, Ted Kennedy campaigned for comprehensive national health insurance (NHI)—a single payer, compulsory system open to all.  It was much like the “public option” touted by liberals in 2009-10.  Kennedy’s backing was personal:  he saw healthcare reform as his contribution to his family’s legacy.  Medical treatment was a civil right.  Kennedy often pointed out that “We are the only industrialized nation in the world outside [apartheid] South Africa that does not have universal, comprehensive healthcare insurance.  And here, as well as in South Africa, black people are sick twice as often; they receive less care; they die younger; and sooner.”

But the NHI proposal did not start or end with Ted Kennedy. The multi-million member Campaign for National Health Insurance (CNHI) was bankrolled by the AFL-CIO and managed by the United Auto Workers union.  So convinced was labor of the popularity of reform that they refused to endorse any healthcare package other than NHI.  In 1975, Kennedy pulled out of negotiations with Gerald Ford over a compromise bill because the CNHI denounced it.  Polls showed that the Democrats would recapture the presidency in 1976, so why, they asked, accept a tepid Republican offer?  Wait a year or so and the Democrats could put together their own.  The CNHI didn’t count on Jimmy Carter being the nominee.

As a presidential candidate in 1976, Carter equivocated on NHI.  In truth, this Southern moderate never liked the idea.  A proto-Clinton, he preferred low-cost free-market solutions to public ills.  Nonetheless, in order to win over the money and manpower of the UAW, Carter endorsed NHI.  After his election, he put Great Society architect Joseph Califano (head of Health Education and Welfare) in charge of drawing up legislation.  The UAW met with Califano and was shocked when he told them not to expect the support of the president for reform.  He eventually quit his job in frustration at stonewalling by Carter.

In office, Jimmy Carter’s biggest challenge was bringing down double digit inflation.  In 1978, he proposed a budget that cut the deficit by reducing social spending.  Facing mounting pressure by liberals, the administration endorsed an NHI proposal in July 1978.  President Carter promised reform in three stages.  The first—and the only ever defined—stage was a hospital cost-containment bill designed to deflate medical bills.  Ted Kennedy was shocked.  The administration made no commitment to comprehensive coverage and the cost-containment package was likely actually to raise the price of healthcare as doctors hiked other charges to cover any loss in revenues.  Worse still, the administration insisted that any future program be run by private insurers:  there would be no “public option” for consumers to buy from the government.

Ted Kennedy denounced the Carter proposal and support for it in Congress collapsed.  In this sense, it is accurate to say that Kennedy killed the bill.  But Kennedy had no choice but to denounce it—it didn’t meet his own publicly stated conditions for reform and the CNHI wouldn’t stand for it.  In December 1978, at a midterm party convention, Kennedy gave a speech calling for a public option.  He received a standing ovation and most interpreted his oratory as the first shot in the war for the 1980 Democratic presidential nomination.

Were liberals mad to throw away this opportunity for reform, no matter how slight?  The polls said not.  By 1979, Kennedy was the universal favorite to replace Carter as the Democratic nominee in 1980.  Polls put him ahead of both Carter and the Republican candidate Ronald Reagan by margins of 2-1. All Kennedy had to do, the CNHI advised, was enter the primaries, beat Carter, beat Reagan, and then he could push through congress the legislation he wanted.

Ultimately, Ted Kennedy’s presidential ambitions were thwarted by historical accident.  In late 1979, hostages were seized at the US embassy in Tehran and the USSR invaded Afghanistan.  These crises, and the media’s revisiting of the Chappaquiddick tragedy, gave Carter a bump in support and helped him win enough early primaries to clinch the nomination.  Liberals backed the wrong horse and healthcare reform didn’t resurface as a possibility until 1993.

Liberals made mistakes in the 1970s, but they were rational errors.  Carter’s claim that he was victimized overlooks the fact that he made liberals many promises (industrial policy, passage of the ERA, labor law reform) that he betrayed.  His statement about Kennedy’s motivations reveals more about himself that it does the late senator.  Carter is an intelligent, compassionate man.  But, beneath that toothy grin, he’s a mean old man with a long memory.

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Arnold Shcherban - 9/24/2010

and would have been right now if killing Obama's care bill, since both the Carter's and Obama's reforms made a joke out of universal, one-payer health
care system needed in this country.

Arnold Shcherban - 9/24/2010

And what is that "shuddering" speculation based on?

Robert T Marston - 9/22/2010

Checking my watch I see it turned out to be only a matters of hours after the 60 Minutes interview of Jimmy Carter that it was met with return fire from Timothy Stanley in the ongoing Kennedy Clan - Carter Clan spitball fight. Allow me to introduce myself. I am Bob Marston one member of the disingenous nonmass Single Payer Healthcare Movement. I have been active in the fight for Single Payer Healthcare since 1994 as a Third Party Congressional Candidate and later as a member of Single Payer Now in the state of California and Healthcare Now nationally. I whole heartedly welcome HNN' s and Mister Stanley' s desire to address the historical context of the subject matter because that aspect of the discussion has been given minimal treatment over the last three years. Unfortunately Mister Stanley's piece contains a number of omissions and a couple of glaring errors. As the topic of public policy on healthcare can be complex and tedious the same can be said for it's history. For this reason I will only touch upon the salient points. For a more thorough understanding I would suggest the reader pick up a copy of "One Nation Uninsured" written by Jill Quadagno (Oxford University Press). Helen Redmond also wrote an excellent editorial entitled "The Lion Sleeps Tonight" published on the Counterpunch.org Website shortly after the passing of Sen. Kennedy September 4, 2009.

The first omission and first error comes when Stanley states : "Throughout the 1970s, Ted Kennedy campaigned for comprehensive national health insurance (NHI)"
Kennedy did indeed campaign for Single Payer in the EARLY 70s. The cold hard fact is CNHI was Walter Reuther's initiative. Reuther as head of the UAW spearheaded the Committee of 100 for National Health Insurance from which CNHI evolved. Kennedy along with US Representative Martha Griffiths coauthored the Health Security Act in 1971. Had it been enacted HSA would have truly been a Single Payer Healthcare System NOT a "Public Option". Unfortunately a split between Reuther and AFL-CIO President George Meany would divide the labor movement which then renegged on the support it promised Kennedy. In May 1970 Reuther was killed in a plane crash and his successor Leonard Woodcock was never a mover and shaker in the political realm of classic labor leaders. Woodcock devoted his efforts to patching up the UAW/AFL-CIO rift. Thus organized Labor left Kennedy high and dry. Angered Kennedy withdrew the bill and met with House Representative Wilbur Mills of Alaska. secretly. The two crafted a bill that most closely ressembled the Individual Mandate scheme we now saddled with today in the form of the Patient Protection and Affordable Care Act (PPACA). It used the term National Health Insurance but retained Private Insurance along with copayments and deductibles while adding "Codeductibles" for supplemental insurance policies. There was very little governmental and nothing optional about his plan.

Mister Stanley then goes on to state : "—a single payer, compulsory system open to all. It was much like the “public option” touted by liberals in 2009-10."
The " Public Option " as advanced by a select number of Congressional Democrats in 2009 was NOT open to all. Rather it was designed to cover those not offered insurance by their employer. There was no way to voluntarily opt out of Employer Group Insurance Plans. Physcians for a National Health Program (PNHP) did an extensive cost analysis of this program and found it's savings so small as to be almost negligible. PNHP found no measurable savings until you got to 50% enrollment, OF ALL AMERICANS. If one was to enroll 95% of all Americans in the "Public Option" PNHP found it would result in a Savings of 64 Billion Dollars annually. Compare that to a savings of 400 Billion Dollars annually if you enrolled the last 5 % of the American Populace along with everyone else in a Single Payer Program ?

Stanley then adds : "The multi-million member Campaign for National Health Insurance (CNHI) was bankrolled by the AFL-CIO and managed by the United Auto Workers union."
As stated before CNHI was Walter Reuther's baby. For accounting purposes one could say the money was coming from the AFL-CIO but one most not forget the UAW was the 800 Pound Gorrilla of the Labor Movement.

As Mister Stanley points out Carter's Health Care Initiative was never about reform but all fairness to Carter he had an additional problem on his plate. That problem was the cash-flow associated with Medicare. Medicare had been setup some 10 years earlier and used a system of reimbursement based upon Capitation. Under that system doctors and hospitals were reimbursed for each illnesses treated based upon a government preset lifetime cost figure. Unfortunately the government lowballed the figures when setting up the system in order to fit under the taxation scheme. This ultimately forced hospitals to cost shift Medicare expense shortfalls on to private insurance tabs. The insurance industry was irrate that their profits were being erroded and pressured the Carter Administration to do something about it. Carter's failure was that he extracted nothing from the Insurance Industry in return for the fix. Since that time Medicare reimbursements have allowed doctors and hospital to operate cash positive with only a very small increase in the withholding tax. The cold hard fact is the only reform that came out of Carter came at the behest of the Private Insurance Industry. If one is serious about getting closer to the truth they should be interviewing Joe Califano and Stuart Eisenstadt.
After Kennedy bailed out on "National Health Insurance" he retained the nomenclature but the 1974 Kennedy-Mills Legislation in no way, shape or form even laid down a foundation for a Single Payer System the way Kennedy-Griffiths did. After the introduction of Kennedy-Mills all discussion about healthcare centered around "Universal Coverage" with that term implying one thing, recipients purchase Insurance. The term "Public Option" would not appear until 2000 when Jacob Hacker's idea surfaced.The fact of the matter is the "Public Option" was recognizable to only a small cult following for the next 8 years. In 2008 a group of renegades who left the Single Payer Healthcare Movement lead by Richard Kirsch MD gave a sense of legitimacy to the concoction. But a "sense" was all it that was, not even Obama bought in to their snake oil.. Eager to latch on to any reform measure that didn't involve a fight with the insurance industry the "Public Option" was a big hit with the faint of heart within the Democrat Party. Unfortunately win-win solutions rarely amount to anything of substance and the "Public Option" is no exception.
Returning to Timothy Stanley's initial mischaracterization of the Modern Healthcare Movement as neither genuine or mass based one needs to look no further than Robert Gibbs outburst to the news media a few weeks ago. It is quite true the decline in Unionization of the US Workforce has slowed efforts at organizing. But one must remember the Healthcare Movement was left for dead by the late 80s. At that time a group of doctors from Harvard University's Medical School formed what would become the most preminent research foundation on health policy in the country today. Physcians for a National Health Program boasts a rapidly growing membership of 17,000 physcians included among them are Marcia Angell MD, the first woman editor of the New England Journal and teaching Professor at Harvard University of Medicine and John Geyman MD Professor Emeritus of Family Medicine at the University of Washington School of Medicine. Doctor Geyman is a registered Republican. Two of the founders of PNHP David Himmelstein MD and Steffie Woolhandler MD were both teaching professors at Harvard University whose research unit has fueled the discussion of healthcare with insightful and revealing data used by everyone in the healthcare debate over the past 15 years. Compare this to the medical profession's stance on Public Healthcare Policy 60 years ago. In 1948 the medical profession lead by the AMA spearheaded a vicious campaign to scuttle Harry Truman's attempt at Universal Healthcare which was successful. Sixty years later the AMA is the shell of the powerhouse they were in the 50s representing only 17 percent of the profession. The University of Illinois Medical Center polls doctors every 5 years to gauge their perspective on varios aspects of the profession. Their last poll was conducted in 2007. That poll found 59 % of doctors now support a Single Payer Healthcare System compared to 31 % that opposed it. In 2002 UoIll Med found 49 % doctors supported Single Payer. The abrupt shift in attitude among the medical community on this issue is dramatic, stark and irreversible. To appreciate the irreversible nature of this phenomenon one must understand the demographics of those practicing medicine. The young doctors support Single Payer overwhelmingly while the Older Generation adhere to the old ways. This is the reason why the University of Illinois poll picked up the substantial increase in sentiment supporting Single Payer between 2002 and 2007. As more older doctors retire one can expect to see similar gains supporting Single Payer in the future.
Among the rank and file of organized labor healthcare is a very big concern. When bargaining time comes around the matter of employee healthcare benefits is the number one issue on the table slated for givebacks. And employers are now doing everything possible to offload retiree healthcare benefits on to the Unions themselves. Union support for Single Payer is high on the shop floor and even Richard Trumpka can be heard advocating for it every now and then. But sadly Union Leadership always manages to forget it roots when election time comes around. Instead of pressing for Key Issues when they have the most leverage leadership pulls in it's horns and sinks into the muck of "we have elect the Democrat no matter what". They did this with Obama and what they got was President "No Matter What" on a whole host of issues. This problem is nothing new for labor and there are movements forming within the rank and file to put serious pressure on leadership. This is what drove Tony Mazzocci to form Labor Party Advocates. Until this problem is dealt with successfully the healthcare movement will always be bedeviled with the fickle behavior that has dogged organized labor since 1968.
In terms of grassroots organizing the Modern Healthcare Movement has a number of citizen groups that provide a bedrock foundation that never existed during the 70s. Groups like Health Care for All which are active in 30 states along with several other independent groups that are working on passing Single Payer on a Statewide Level. Single Payer Now in California has been responsible for push through Single Payer Legislation through Sacramento twice. SPN has a large and growing database through out the state with canvassers collecting contact information in the Los Angeles and San Francisco Bay Areas. Right now there are campaigns to legislate Single Payer Healthcare Systems in a dozen states. Nothing like this ever existed in the 70s. During that time Healthcare was one issue on an agenda of many held by Senior Advocacy and Labor Groups. Those groups were never dedicated to Healthcare Issues muchless Single Payer.
Is this activity getting the attention of the Democrat Party ? Judging from the chacanery coming from those quarters it sure is. I'm talking about setting up Rump Organizations like Doctors for America and Healthcare for America Now (not to be confused with Heathcare Now) in order to confuse and divert unwitting souls from joining forces with Single Payer Groups. Foisting the "Public Option" on an unknowing public and passing it off as a measure possessing substance. These guys make Dick Nixon look like a prince !
So yes Mister Stanley the healthcare movement was larger back in the 70s than it is right now. But the current Single Payer Movement has a much firmer base and it has the Public Mind based upon the media coverage it receives. It will only be a matter of time, maybe 2 to 3 years before the American People realize they were sold a Pig in a poke with Barack Obama's PPACA. Regarding the record of both Jimmy Carter or Ted Kennedy on the matter of healthcare one need look no further than WHO and OECD data of current US Healthcare performance and then compare what either individual proposed as their solution to the problem. What becomes readily apparent to even the casual observer is both the Kennedy and Carter proposals amounted to little more than piece-meal tinkering in a system crying out for fundamental reform. The record of either man on the matter of Healthcare Policy is nothing to write home about.

Bob Marston
Single Payer Now

Jeff Ray - 9/22/2010

How is this for a gloss over, " the media’s revisiting of the Chappaquiddick tragedy." That is why Teddy did not win the primary and never could have won.

james joseph butler - 9/21/2010

"And the media's revisiting of Chappaquidick" Right and wrong again. "Liberals backed the wrong horse." And the winner is....

Politics, always personal, one is a peanut farmer the other a lyin scion who can't remember why he's the guy. Teddy and Jimmy both wanted to do the right thing, we got eight years of Ronnie's dreams. On this new morning......

Donald Wolberg - 9/21/2010

Mr. Hughes is correct of course, but one also shudders at the "what if" had Mr. Carter managed to be elected again. Mr. Carter is a very peculiar fellow, indeed.

Lawrence Brooks Hughes - 9/20/2010

One shudders to think how many medical breakthroughs would have been delayed for decades if Jimmy Carter had been allowed to put the yoke of nationalized health care on America 32 years ago, in 1978!