Health­care’s ‘Lion’

Se­na­tor’s life­work was de­voted to re­form­ing sys­tem

Modern Healthcare - - Health Care Hall of Fame - Jen­nifer Lubell

It was a defin­ing mo­ment in Ed­ward Kennedy’s ca­reer. As the U.S. Se­nate was cast­ing a decisive vote on key Medi­care leg­is­la­tion on a hot July day in 2008, a hush fell over the cham­ber as a fa­mil­iar white cloud of hair en­tered the premises.

The si­lence ex­ploded into thun­der­ous ap­plause as an ail­ing Kennedy, struck down by a brain tu­mor, cast a cru­cial vote to en­sure a veto-proof mar­gin and pas­sage of the Medi­care Im­prove­ments for Pa­tients and Providers Act of 2008, which made sig­nif­i­cant changes to the Medi­care Ad­van­tage pro­gram, while stop­ping a 6% pay­ment cut to doc­tors.

“Sen. Kennedy has al­ways been a war­rior for health­care, and when he came to Wash­ing­ton that day, tens of mil­lions of Amer­i­cans were re­minded that they’ve al­ways had a cham­pion in Ted Kennedy,” Sen. Max Bau­cus (DMont.), chair­man of the Se­nate Fi­nance Com­mit­tee, said af­ter the his­toric vote. “Ted made all the dif­fer­ence.”

Even the Repub­li­cans rose to ap­plaud the se­na­tor whom they hadn’t seen since he had started in­ten­sive treat­ments to ward off can­cer.

Kennedy suc­cumbed to his ill­ness last Au­gust at age 77, but in his 47 years as a se­na­tor, Kennedy be­came Congress’ chief health­care ac­tivist.

“No­body in the his­tory of the coun­try was more ef­fec­tive in mov­ing the na­tion closer to achiev­ing mean­ing­ful health­care re­form,” says Ron Pol­lack, ex­ec­u­tive di­rec­tor of ad­vo­cacy group Fam­i­lies USA. Pol­lack worked closely with Kennedy on health­care is­sues for at least three decades.

The hospi­tal in­dus­try also lost an im­por­tant ally on Capi­tol Hill with Kennedy’s death.

“Nowhere has he had more of an im­pact than on ef­forts to im­prove our na­tion’s health­care sys­tem,” says Richard Umb­den­stock, pres­i­dent and CEO of the Amer­i­can Hospi­tal As­so­ci­a­tion. “A friend to hos­pi­tals, pa­tients and com­mu­ni­ties in Mas­sachusetts and across the coun­try, Sen. Kennedy fought to im­prove health­care and ex­pand ac­cess and cov­er­age for all. … De­spite a dev­as­tat­ing ill­ness, Sen. Kennedy con­tin­ued to fight for health­care re­form. His ex­ten­sive knowl­edge of the health­care sys­tem and the in­ner work­ings of Congress, and his abil­ity to build con­sen­sus will be greatly missed as dis­cus­sions con­tinue on how to best im­prove health­care.”

Prin­ci­pled but prag­matic

Known as the “Lion of the Se­nate,” the Mas­sachusetts Demo­crat was dubbed with many other la­bels over the years. The ul­ti­mate lib­eral. A prag­matic and dogged worker. But Kennedy may be best known for his abil­ity to buck con­ven­tion, to reach across par­ti­san lines to find con­sen­sus on is­sues.

“Many con­sider him to be the finest leg­is­la­tor in the last 50 years. He was re­spected across the aisles and could work with peo­ple op­posed to him and try to find mid­dle ground, which is what we so badly need” to­day, says Stu­art Alt­man, a pro­fes­sor of health­care pol­icy at Bran­deis Uni­ver­sity. Alt­man worked with Kennedy when Alt­man was a young health pol­icy aide in Pres­i­dent Richard Nixon’s ad­min­is­tra­tion.

Alt­man met Kennedy dur­ing a piv­otal point in the se­na­tor’s ca­reer: when he be­came chair­man of the Se­nate Health sub­com­mit­tee and filed his first bill to pro­mote uni­ver­sal cov­er­age in 1971.

“I was part of the Nixon ad­min­is­tra­tion, there­fore I looked like I was the en­emy” to con­gres­sional Democrats, Alt­man says. Kennedy may have been sus­pi­cious of Alt­man when they first met, but per­haps it was the de­sire of each of th­ese men to reach across the aisles that sealed their abil­ity to work to­gether.

“I re­ally didn’t fit the mold of what was ex­pected out of a Nixon em­ployee,” Alt­man says. In turn, Kennedy seemed to be “a prag­matic guy that wanted to do the right thing.” He and Kennedy worked to­gether in the early 1970s to cre­ate a fi­nanc­ing mech­a­nism for med­i­cal schools to re­ward them for in­creas­ing the num­ber of new physi­cians.

Kennedy was of­ten ac­cused by po­lit­i­cal op­po­nents of be­ing the ul­ti­mate lib­eral, but when try­ing to craft a bi­par­ti­san com­pro­mise he was the ul­ti­mate prag­ma­tist, Alt­man says. When Nixon of­fered up his own re­form bill, the Na­tional Health In­sur­ance Part­ner­ship Act, “Kennedy was will­ing to work with us on a com­pro­mise we could all sup­port,” de­spite the fact he thought the plan was more of a part­ner­ship be­tween the ad­min­is­tra­tion and in­sur­ance com­pa­nies than a part­ner­ship be­tween pa­tients and physi­cians, Alt­man says.

“He broke with ad­vo­cates to sup­port or try to come up with a truly bi­par­ti­san ap­proach,” ac­cord­ing to Alt­man.

His son Rep. Pa­trick Kennedy (D-R.I.) says Ed­ward Kennedy’s abil­ity to bro­ker deals, with the left and right, was his great­est ac­com­plish­ment. “The les­son of his life and the les­son of his pol­i­tics was per­se­ver­ance,” he says.

“His great­est tes­ta­ments to the leg­isla­tive process was how much he did dur­ing the lean years for Democrats, the years when they didn’t have the ma­jor­ity, when the po­lit­i­cal winds weren’t blow­ing in their di­rec­tion,” in­clud­ing the Rea­gan years, Pa­trick Kennedy adds.

At the same time Ed­ward Kennedy was push­ing for broader re­form needs, he would look for op­por­tu­ni­ties to make in­cre­men­tal im­prove­ments and did so in a way that se­cured bi­par­ti­san sup­port no other mem­ber of Congress was suc­cess­ful in achiev­ing, says Pol­lack, who col­lab­o­rated with Kennedy on a num­ber of bills that were suc­cess­fully en­acted into law, in­clud­ing the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act, State Chil­dren’s Health In­sur­ance Pro­gram and the Medi­care Mod­ern­iza­tion Act of 2003.

Pres­i­dent Barack Obama last year called Kennedy “the great­est par­ti­san in Congress,” Pa­trick Kennedy re­calls. Ed­ward Kennedy’s lib­eral views, how­ever, “didn’t keep him from be­ing

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