Editor’s Note: During his 47 years in the Senate, the late Senator Edward Kennedy of Massachusetts was a lion of U.S. health care and health policy. We at Health Affairs, along with much of the rest of America, grieve at his passing. We recently asked Democratic and Republican politicians, policy experts, and former Senate staff to write for us about the senator’s many contributions. We now publish several of these on the Health Affairs Blog, including the piece by David Blumenthal below, and will also issue Web Exclusive versions for the archives in the weeks to come.
– Susan Dentzer, Editor-in-Chief
When I learned of Senator Edward M. Kennedy’s death, I shared with millions around the world a deep sense of personal and professional loss. Inevitably, the personal dominated. Here was a man, great and flawed, mythical and mortal, who could operate with equal comfort on the world stage and in personal relationships. He affected the history of nations and of countless unheralded individuals who passed through the powerful force field that he projected. I was lucky to be one of those individuals.
I was not an intimate of Ted Kennedy. He was, at heart, a boisterous, expansive Boston Irish politician. I was a Jewish physician-academic. But he found a place for me, like so many others of every background and persuasion, in his huge circle of well-wishers, loyalists, admirers, and yes, friends. In the end, no one had greater influence on my professional life or taught me more about my work, about health policy and politics, and about greatness.
Kennedy As Legislator: Excellence At Work
My education began during a brief but electric period in the late 1970s, when I was a professional staff member on his Senate health subcommittee. I joined him within days of Jimmy Carter’s inauguration, and with a new Democratic president and Democrats controlling both houses of Congress, the political possibilities for Kennedy and his progressive agenda seemed almost limitless. Only later, after studying the history of health policy, would I come to fully understand the paradox of this historical period, which witnessed the final dissolution of FDR’s New Deal coalition and the beginning of a long era of conservative dominance in American politics.
But that was not apparent at the time. Instead, I watched as Kennedy worked tirelessly on the many causes and issues — in both health and other areas — that he loved to juggle. He had an almost insatiable appetite for new ideas, for action, for change, and for movement. Kennedy was a policy and political entrepreneur. No health care issue was too minor or obscure, as long as it affected the real problems of real people.
He was not an academic. He was not always articulate. But he combined uncanny political skills with an unerring humanism. And he did his homework. Like so many of his staff, I cherished the times when, before a hearing or a markup, I would get the chance to sit with him, often alone, as he peppered me with questions about some legislative provision or idea that few of his Senate colleagues would ever care much about. Through this diligence, he earned my loyalty and respect, and that of his colleagues as well.
It was not just in the details of legislation that his skills were manifest. When it came to fashioning national health insurance bills, he had an instinctive understanding of how to bound this seemingly endless process, how to set the key parameters that would ultimately shape the legislation, and how to organize a process that would get it done. It was not by chance that Kennedy’s committee was the first and only one to report out President Clinton’s health reform proposal, or the first to report out President Obama’s.
Watching Kennedy, I learned that there was a form of excellence that was totally different from, and much rarer than, the technical and scholastic brilliance that had so impressed me during my academic training. Kennedy had the energy, drive, temperament, and personal skills of a great legislator. He could capture the imagination of millions and translate their hopes into the black and white of legislative language. Then he could maneuver that legislation through the labyrinth of the American legislative process. Here was a species, the charismatic leader and legislative strategist, who would make a mark on history.
Senator Kennedy’s Courage
Kennedy taught me something else about politicians who rise above the crowd: They have moral and political courage. His moral courage was constantly on display through his advocacy — often alone or in a small minority — of universal health care coverage and many other causes. In 1972 , well before I knew him, he broke with the labor movement — much more powerful then than now — when he decided to embrace a compromise national health insurance bill that he had worked out with Wilbur Mills, a conservative Democrat who chaired the House Ways and Means Committee at the time. Kennedy saw a chance to push through a bill in the waning days of the Nixon presidency, and despite his nascent presidential ambitions, was willing to sacrifice the support of what could be the most important Democratic constituency for a presidential run.
Later, time after time, Kennedy rose — in the Senate, at conventions, at rallies — to keep his party focused on universal health insurance, as he did, in his waning days, during the 2008 campaign. Pragmatic centrists often ground their teeth over his persistence. But he would not be silent. And his stalwart advocacy, like Harry Truman’s a generation earlier, contained the stuff of greatness.
Kennedy’s physical courage was less obvious, but no less impressive. I saw it repeatedly during his unsuccessful campaign for the presidency in 1980. So concerned was Kennedy’s family about an assassination attempt that they insisted he have a physician with him at all times. I had returned to Massachusetts to complete a residency in internal medicine. But like all former aides, I remained a trusted part of the extended Kennedy staff, so they tapped me to travel with him when he appeared publicly in Massachusetts.
Several memories have stayed with me from that brief period before his campaign collapsed, amid much speculation about whether he ever really wanted the job. One was the eerie task of assembling a makeshift life support kit — the basic drugs and equipment necessary to keep someone alive — that could fit into a metallic briefcase that I would carry whenever I was with him. Another memory is my overwhelming sense of vulnerability as I sat or stood near him in open public gatherings — a Harvard football game, a Catholic mass on the Boston Common when the Pope visited his hometown, the opening of the Kennedy Library. Kennedy had Secret Service protection (indeed, I was often mistaken for an agent), but I quickly understood in my gut what I knew intellectually: that there was no way truly to protect him from an assassin’s bullet. Surely he knew that, but he lived with that reality not just in Massachusetts, but in far less friendly regions of this huge and diverse country.
Greatness & Empathy
Perhaps the most important lesson, however, that I learned through my public service with Senator Edward Kennedy was the importance of the personal, and the way in which truly great politicians manage, unerringly, to focus on the individuals whom they encounter. The news media have been full recently of stories about the ways in which Kennedy — without publicity or any expectation of gain — reached out to help ordinary people. Though, fortunately, I never needed his personal assistance, I always knew it would be there if I did. He combined greatness with empathy.
One time, after a legislative ambush engineered by Senator Robert Dole and his brilliant young staffer, Sheila Burke, defeated a relatively minor bill I was helping Kennedy shepherd through the Senate, Kennedy blew up. “How can I pass national health insurance if I can’t get this thing through the Senate,” he exploded. His face was red, his expression dark. I was devastated. The next morning I was at my desk at 8 a.m. trying to figure out how to rescue the situation, when my phone rang. It was Kennedy. He apologized for losing his temper, told me not to worry, that we would find a way out, and thanked me for my work.
From the time I met Senator Edward Kennedy in 1977, I have used him as the yardstick of political greatness in every public figure I have met. Very few have measured up, and few ever will.