ROBERT SIEGEL, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MELISSA BLOCK, host:
And I'm Melissa Block.
For nearly 50 years, Senator Edward Kennedy was a champion of liberal causes: civil rights, immigration, and his most enduring fight, universal health care. That fight started with this ad from his first Senate campaign, in 1962.
(Soundbite of TV ad)
Senator EDWARD KENNEDY (Democrat, Massachusetts): Too many of our senior citizens are being forced to choose between neglecting their ailments or being pauperized by them.
BLOCK: It was Kennedy's biggest legislative disappointment that he was never able to steer a universal health-care bill safely through Congress. Still, as NPR's Julie Rovner reports, he left a lasting mark on the nation's health-care system.
JULIE ROVNER: The list of health-care bills written or sponsored or somehow negotiated by Kennedy over his Senate career literally fills books. He expanded children's health insurance coverage. He provided funding to fight HIV and AIDS. He crafted policies to protect the nation from bioterrorism. He was basically a one-man, health-policy history lesson. Brandeis University professor Stuart Altman has been in and around health policy since 1971.
Professor STUART ALTMAN (Brandeis University): I guess I'm getting up there in terms of years, and there is no one that comes close, not even 10 percent close, to what Senator Kennedy has done and what he stood for.
ROVNER: Kennedy started standing for health care when he first ran for the Senate seat originally left vacant when older brother John was elected President.
(Soundbite of TV ad)
Unidentified Man: A man who cares: Edward M. Kennedy, endorsed Democratic candidate for the United States Senate.
ROVNER: In a three-and-a-half-minute, black-and-white television ad, a youthful Ted Kennedy is seen pushing for passage of Medicare. Here he's shown interviewing Lynn, Massachusetts, resident Helen Clancy.
(Soundbite of TV ad)
Sen. KENNEDY: Have you noticed that there has been an increase in medical expenses in the past few years?
Ms. HELEN CLANCY: Decidedly 75 or 85 percent more.
Sen. KENNEDY: Have you had any illness recently in which - has eaten up a portion of your income?
Ms. CLANCY: Well, I had hospitalization for 10 days, the first of the year, which cost over $400.
ROVNER: Kennedy would see Medicare passed after his brother's death. A few years later, he pushed for the expansion of a relatively small program created as part of Lyndon Johnson's War on Poverty. Today, the community health centers program serves some 16 million Americans. By the 1970s, Kennedy had become a force to be reckoned with in health care. David Blumenthal, who now works in the Obama administration, worked for Kennedy in those days. He said Kennedy liked issues that would bring publicity, particularly because he still harbored hopes of running for president.
Dr. DAVID BLUMENTHAL (National Coordinator, Health Information Technology, Health and Human Services Department): But he wasn't just about cameras. He was also about long hearings about biomedical research, long hearings about how to prevent illness, long hearings about technology and its effect on health care and how to measure it and evaluate it.
ROVNER: And despite his reputation as a far-left liberal, Kennedy the legislator was always ready to look for a compromise. In the early 1970s, Stuart Altman worked for President Nixon, trying to draft a national health insurance plan. Kennedy secretly sent his top aides to meet with Altman in a church basement near the Capitol. At that point, Kennedy was pushing for a fully government-run plan, while Nixon wanted to require employers to provide private coverage. But Altman says Kennedy was willing to try to find common ground.
Prof. ALTMAN: The problem, of course, is that Kennedy was way out in front of his more liberal compatriots, and we were way out in front of the more conservative and ultimately, the whole thing blew apart. But it impressed on me that at the end of the day, Senator Kennedy wanted to make changes that helped people and if it meant moving away from his preferred position to a compromise, he was willing to do it.
ROVNER: In 1980, Kennedy lost what would be his last chance to become president, after he failed to defeat President Jimmy Carter in the primaries. That fall, he also lost his legislative power when the Republicans took over the Senate. But he managed to adapt once again. This time, he forged a most unlikely alliance with conservative Utah Republican Orrin Hatch. Together in the 1980s and 1990s, the two teamed up to pass landmark legislation including the Ryan White AIDS law, children's health insurance program, and bills to streamline drug approvals at the Food and Drug Administration, among others.
Senator ORRIN HATCH (Republican, Utah): We've been a very active and successful team, where we've covered the universe from the left to the right.
ROVNER: Kennedy, however, wasn't willing to compromise away his fundamental beliefs. In 2003, he voted for the initial version of a Medicare prescription drug bill, in order to advance a cause he'd been pursuing for years. But he was furious that the final version was too favorable to the drug and insurance companies. Here's how he put it at a rally for senior citizens on Capitol Hill, the same day President Bush signed the bill.
Sen. KENNEDY: Who do you trust to fix the Medicare program: the HMO-coddling, the drug company-loving, the Medicare-destroying, the Social Security-hating Bush administration? Or do you trust Democrats who created Medicare and will fight to defend it every day, every week, every month and every year?
ROVNER: Kennedy didn't always win. He spent nearly a decade trying in vain to pass a so-called patients' bill of rights. But usually his persistence paid off. When Democrats took the Senate back in 2007, Kennedy made up for lost time. He steered through two bills that had each languished for more than a decade. One banned insurance discrimination based on a person's genetic makeup; the other required insurers to provide the same level of coverage for mental as for physical ailments. And he began the painstaking task of laying the groundwork for yet another push for universal health insurance coverage. He renewed that call in his surprise appearance at the Democratic National Convention in 2008, even in the midst of his cancer treatment.
Sen. KENNEDY: And this is the cause of my life, new hope that we will break the old gridlock and guarantee that every American — north, south, east, west, young, old — will have decent, quality health care as a fundamental right and not a privilege.
(Soundbite of cheering)
ROVNER: Kennedy returned to Washington on and off in the early part of the Obama administration. He was an early and strong supporter of the new president. But he did not live long enough to see that final dream realized.
SIEGEL: That's NPR's Julie Rovner. And Julie, we know that as recently as last month, Senator Kennedy was actively involved, by telephone at least, in steering a health-care bill through his Senate committee. Without him, what happens now?
ROVNER: Well, he does represent the loss of that critical 60th vote in the Senate - and the governor cannot appoint someone to take his place. There will have to be a special election. That won't happen for a few months. On the other hand, it's not at all clear that the Democrats ever really had 60 votes for health-care overhaul. There were several moderate Democrats who have been wavering quite a bit. So that's not really going to be such an issue.
SIEGEL: Given Senator Kennedy's record for reaching across the aisle, for developing compromises in the Senate, do you think that if he had been well this past year and if he had been more active in the health-care debate, that perhaps things wouldn't be quite so partisan as they are now?
ROVNER: Well, that's one that you really have to wonder about. I've seen a number of Republicans over the past couple of weeks ask that same question. And they've all said, you know, that really might be - that Senator Kennedy really had an amazing ability, for all his liberal leanings, to reach across the aisle, to work with Republicans, to find ways to find a middle ground.
Now, it may be that this was just destined to become partisan because the Republicans want so badly to give President Obama a big loss. But it may also just be that Senator Kennedy might have been able to find some of those middle-ground places in this debate.
SIEGEL: Thank you, Julie.
ROVNER: You're welcome.
SIEGEL: That's NPR health policy correspondent Julie Rovner.