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