Academics From The United States

"This would threaten not just the health of Americans but also the strength of the American economy. Health-care spending already accounts for 17 percent of our entire domestic product. In other advanced nations, where the figure is around 10 percent, everyone has insurance and health outcomes that are equal or better than ours. This disparity undermines our ability to compete and succeed in the global economy. General Motors spends more per vehicle on health care than on steel."

"I've heard the critics complain about the costs of change. I'm confident that at the end of the process, the change will be paid for—fairly, responsibly, and without adding to the federal deficit. It doesn't make sense to negotiate in the pages of NEWSWEEK, but I will say that I'm open to many options, including a surtax on the wealthy, as long as it meets the principle laid down by President Obama: that there will be no tax increases on anyone making less than $250,000 a year. What I haven't heard the critics discuss is the cost of inaction. If we don't reform the system, if we leave things as they are, health-care inflation will cost far more over the next decade than health-care reform. We will pay far more for far less—with millions more Americans uninsured or underinsured."

"Another cardinal principle of reform: we have to make certain that people can keep the coverage they already have. Millions of employers already provide health insurance for their employees. We shouldn't do anything to disturb this. On the contrary, we need to mandate employer responsibility: except for small businesses with fewer than 25 employees, every company should have to cover its workers or pay into a system that will. We need to prevent disease and not just cure it. (Today 80 percent of health spending pays for care for the 20 percent of Americans with chronic illnesses like diabetes, cancer, or heart disease.) Too many people get to the doctor too seldom or too late—or know too little about how to stay healthy. No one knows better than I do that when it comes to advanced, highly specialized treatments, America can boast the best health care in the world—at least for those who can afford it. But we still have to modernize a system that doesn't always provide the basics."

"All Americans should be required to have insurance. For those who can't afford the premiums, we can provide subsidies. We'll make it illegal to deny coverage due to preexisting conditions. We'll also prohibit the practice of charging women higher premiums than men, and the elderly far higher premiums than anyone else. The bill drafted by the Senate health committee will let children be covered by their parents' policy until the age of 26, since first jobs after high school or college often don't offer health benefits. To accomplish all of this, we have to cut the costs of health care. For families who've seen health-insurance premiums more than double—from an average of less than $6,000 a year to nearly $13,000 since 1999—one of the most controversial features of reform is one of the most vital. It's been called the "public plan." Despite what its detractors allege, it's not "socialism." It could take a number of different forms. Our bill favors a "community health-insurance option." In short, this means that the federal government would negotiate rates—in keeping with local economic conditions—for a plan that would be offered alongside private insurance options. This will foster competition in pricing and services. It will be a safety net, giving Americans a place to go when they can't find or afford private insurance, and it's critical to holding costs down for everyone."

"To help finance a bill, the pharmaceutical industry has agreed to lower prices for seniors, not only saving them money for prescriptions but also saving the government tens of billions in Medicare payments over the next decade. Senator Baucus has agreed with hospitals on more than $100 billion in savings. We're working with Republicans to make this a bipartisan effort. Everyone won't be satisfied—and no one will get everything they want. But we need to come together, just as we've done in other great struggles—in World War II and the Cold War, in passing the great civil-rights laws of the 1960s, and in daring to send a man to the moon. If we don't get every provision right, we can adjust and improve the program next year or in the years to come. What we can't afford is to wait another generation."

"Incremental measures won't suffice anymore. We need to succeed where Teddy Roosevelt and all others since have failed. The conditions now are better than ever. In Barack Obama, we have a president who's announced that he's determined to sign a bill into law this fall. And much of the business community, which has suffered the economic cost of inaction, is helping to shape change, not lobbying against it. I know this because I've spent the past year, along with my staff, negotiating with business leaders, hospital administrators, and doctors. As soon as I left the hospital last summer, I was on the phone, and I've kept at it. Since the inauguration, the administration has been deeply involved in the process. So have my Senate colleagues—in particular Max Baucus, the chair of the Finance Committee, and my friend and partner in this mission, Chris Dodd. Even those most ardently opposed to reform in the past have been willing to make constructive gestures now."

"That didn't happen as soon as I thought it would. When Bill Clinton returned to the issue in the first years of his presidency, I fought the battle in Congress. We lost to a virtually united front of corporations, insurance companies, and other interest groups. The Clinton proposal never even came to a vote. But we didn't just walk away and do nothing—even though Republicans were again in control of Congress. We returned to a step-by-step approach. With Sen. Nancy Landon Kassebaum of Kansas, the daughter of the 1936 Republican presidential nominee, I crafted a law to make health insurance more portable for those who change or lose jobs. It didn't do enough to fully guarantee that, but we made progress. I worked with my friend Sen. Orrin Hatch of Utah, the Republican chair of our committee, to enact CHIP, the Children's Health Insurance Program; today it covers more than 7 million children from low-income families, although too many of them could soon lose coverage as impoverished state governments cut their contributions."

"Some years later, I decided the time was right to renew the quest for universal and affordable coverage. When I first introduced the bill in 1970, I didn't expect an easy victory (although I never suspected that it would take this long). I eventually came to believe that we'd have to give up on the ideal of a government-run, single-payer system if we wanted to get universal care. Some of my allies called me a sellout because I was willing to compromise. Even so, we almost had a plan that President Richard Nixon was willing to sign in 1974—but that chance was lost as the Watergate storm swept Washington and the country, and swept Nixon out of the White House. I tried to negotiate an agreement with President Carter but became frustrated when he decided that he'd rather take a piecemeal approach. I ran against Carter, a sitting president from my own party, in large part because of this disagreement. Health reform became central to my 1980 presidential campaign: I argued then that the issue wasn't just coverage but also out-of-control costs that would ultimately break both family and federal budgets, and increasingly burden the national economy. I even predicted, optimistically, that the business community, largely opposed to reform, would come around to supporting it."

"For the next generation, no one ventured to tread where T.R. and Truman fell short. But in the early 1960s, a new young president was determined to take a first step—to free the elderly from the threat of medical poverty. John Kennedy called Medicare "one of the most important measures I have advocated." He understood the pain of injury and illness: as a senator, he had almost died after surgery to repair a back injury sustained during World War II, an injury that would plague him all of his life. I was in college as he recuperated and learned to walk without crutches at my parents' winter home in Florida. I visited often, and we spent afternoons painting landscapes and seascapes. (It was a competition: at dinner after we finished, we would ask family members to decide whose painting was better.) I saw how the pain would periodically hit him as we were painting; he'd have to put down his brush for a while. And I saw, too, how hard he fought as president to pass Medicare. It was a battle he didn't have the opportunity to finish. But I was in the Senate to vote for the Medicare bill before Lyndon Johnson signed it into law—with Harry Truman at his side. In the Senate, I viewed Medicare as a great achievement, but only a beginning. In 1966, I visited the Columbia Point Neighborhood Health Center in Boston; it was a pilot project providing health services to low-income families in the two-floor office of an apartment building. I saw mothers in rocking chairs, tending their children in a warm and welcoming setting. They told me this was the first time they could get basic care without spending hours on public transportation and in hospital waiting rooms. I authored legislation, which passed a few months later, establishing the network of community health centers that are all around America today."

"Our response to these challenges will define our character as a country. But the challenges themselves—and the demands for reform—are not new. In 1912, when Theodore Roosevelt ran for a third term as president, the platform of his newly created Progressive Party called for national health insurance. Harry Truman proposed it again more than 30 years after Roosevelt was defeated. The plan was attacked, not for the last time, as "socialized medicine," and members of Truman's White House staff were branded "followers of the Moscow party line.""

"That experience with Teddy made it clear to me, as never before, that health care must be affordable and available for every mother or father who hears a sick child cry in the night and worries about the deductibles and copays if they go to the doctor. But that was just one medical crisis. My family, like every other, has faced many—at every stage of life. I think of my parents and the medical care they needed after their strokes. I think of my son Patrick, who suffered serious asthma as a child and sometimes had to be rushed to the hospital for treatment. (For this reason, we had no dogs in the house when Patrick was young.) I think of my daughter, Kara, diagnosed with lung cancer in 2002. Few doctors were willing to try an operation. One did—and after that surgery and arduous rounds of chemotherapy and radiation, she's alive and healthy today. My family has had the care it needed. Other families have not, simply because they could not afford it."

"Nothing I'm enduring now can compare to hearing that my children were seriously ill. In 1973, when I was first fighting in the Senate for universal coverage, we learned that my 12-year-old son Teddy had bone cancer. He had to have his right leg amputated above the knee. Even then, the pathology report showed that some of the cancer cells were very aggressive. There were only a few long-shot options to stop it from spreading further. I decided his best chance for survival was a clinical trial involving massive doses of chemotherapy. Every three weeks, at Children's Hospital Boston, he had to lie still for six hours while the fluid dripped into his arm. I remember watching and praying for him, all the while knowing how sick he would be for days afterward. During those many hours at the hospital, I came to know other parents whose children had been stricken with the same deadly disease. We all hoped that our child's life would be saved by this experimental treatment. Because we were part of a clinical trial, none of us paid for it. Then the trial was declared a success and terminated before some patients had completed their treatments. That meant families had to have insurance to cover the rest or pay for them out of pocket. Our family had the necessary resources as well as excellent insurance coverage. But other heartbroken parents pleaded with the doctors: What chance does my child have if I can only afford half of the prescribed treatments? Or two thirds? I've sold everything. I've mortgaged as much as possible. No parent should suffer that torment. Not in this country. Not in the richest country in the world."

"But quality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to. This is the cause of my life. It is a key reason that I defied my illness last summer to speak at the Democratic convention in Denver—to support Barack Obama, but also to make sure, as I said, "that we will break the old gridlock and guarantee that every American…will have decent, quality health care as a fundamental right and not just a privilege." For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society. Now the issue has more meaning for me—and more urgency—than ever before. But it's always been deeply personal, because the importance of health care has been a recurrent lesson throughout most of my 77 years."

"In 1964, I was flying with several companions to the Massachusetts Democratic Convention when our small plane crashed and burned short of the runway. My friend and colleague in the Senate, Birch Bayh, risked his life to pull me from the wreckage. Our pilot, Edwin Zimny, and my administrative assistant, Ed Moss, didn't survive. With crushed vertebrae, broken ribs, and a collapsed lung, I spent months in New England Baptist Hospital in Boston. To prevent paralysis, I was strapped into a special bed that immobilizes a patient between two canvas slings. Nurses would regularly turn me over so my lungs didn't fill with fluid. I knew the care was expensive, but I didn't have to worry about that. I needed the care and I got it. Now I face another medical challenge. Last year, I was diagnosed with a malignant brain tumor. Surgeons at Duke University Medical Center removed part of the tumor, and I had proton-beam radiation at Massachusetts General Hospital. I've undergone many rounds of chemotherapy and continue to receive treatment. Again, I have enjoyed the best medical care money (and a good insurance policy) can buy."

"There is a new wave of change all around us, and if we set our compass true, we will reach our destination — not merely victory for our Party, but renewal for our nation. And this November the torch will be passed again to a new generation of Americans, so with Barack Obama and for you and for me, our country will be committed to his cause. The work begins anew. The hope rises again. And the dream lives on."

"We are told that Barack Obama believes too much in an America of high principle and bold endeavor, but when John Kennedy called of going to the moon, he didn't say, "It's too far to get there. We shouldn't even try." Our people answered his call and rose to the challenge, and today an American flag still marks the surface of the moon."

"For me this is a season of hope -- new hope for a justice and fair prosperity for the many, and not just for the few — new hope. 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."

"My fellow Democrats, my fellow Americans, it is so wonderful to be here. And nothing — nothing is going to keep me away from this special gathering tonight. I have come here tonight to stand with you to change America, to restore its future, to rise to our best ideals, and to elect Barack Obama president of the United States."

"Yes. There was going to be no real opportunity to move it during the Reagan period. That’s when, as you might remember, I went from the Judiciary Committee back to the Labor Committee because there was going to be the massive assault on all the domestic programs. And, at that time, there was going to be the consolidation of all the block granting—all of these programs, some of which were block-granted. It seemed to me that it was just going to be important then to try to hold on to where you were in terms of all of the domestic programs, and that’s primarily what we were engaged in. We were involved and active in other issues then. We went to South Africa, and also we had Chile, and we had the arms control issues where there was some of the back-channeling with Reagan. But on the domestic, we weren’t going to get anyplace at all, and that was very apparent to me. What happened is he continued to have the continuing loss of coverage in health insurance and continuing increased expenditures. The indicators were still going the wrong way."

"We had the attention, obviously, of Carter. He understood that the spending on health care was not unrelated to the spending on inflation. But there’s a way of dealing with both of those, and he wasn’t prepared to do that."

"The basic point where it broke down was—He used the technique of saying that he had announced principles and that would be their commitment, and then he’d move on from there. But you have to announce as part of the principles whether you were going to have one bill or several bills, and he would not make it clear that it was going to be one bill, and he wouldn’t make it clear that, even if it was going to be one bill—We talked about, well, then it’s going to have to take the Congress to unwrap it. He wouldn’t go that far. We gave him that kind of alternative to preserve it, but he wouldn’t go there. He would only say, “We’ll get one bill and if we meet the economic points test further on down, then we’ll submit it so that it can have a second phase, and a third phase, and a fourth phase.” And that was the break. That was just completely unacceptable, in spite of the fact that we had a lot of conversation about how to do it and when to do it."

"Carter found out that Califano and I were going to the same meeting, and he heard that they were just talking in general terms, and he became enormously suspicious of Califano. Califano never trimmed on Jimmy Carter’s principles. Wherever Carter came down, he stayed. You’d talk a little bit about it here and there, trying to glad-hand your bid on some of these kinds of things, which I understood. But he never trimmed, never played a game on that thing, and he stayed absolutely consistent. Carter fired him because he thought he was becoming too friendly with me on this, there’s no real question. And once he left—I mean, he was the only one who really understood the healthcare issue—it was gone. Eizenstat was, I thought, a positive. He wanted to be helpful in trying to bridge the gap. Califano didn’t want to have a split. It’s kind of interesting, in these notes, the extent that Jimmy Carter said that he didn’t want to have a split with us."

"Califano and I both went to the Holy Trinity Church here when our children were small, and part of the service was that, after 9:00 or 10:00 mass, the children would go down for Sunday school, and they would have a discussion there for the grownups. They’d have one of the Jesuits who would come over and lead the discussion, and they were always enormously interesting, very interesting, very gifted, talented lecturers. There were always a couple hundred people who were there with their children, and then, at whatever time, an hour later, you would break up and hook up with your children and drive them home."

"You know, it depends on the unions, about where they are. Some of them have got other issues that are as important, if not more important, in terms of the narrow Labor issues. All of the railroad unions were concerned about Amtrak—that’s 31 of the unions who were all concerned about—that’s their particular part of it. The building trades were concerned about independent contracting. And they’re worried about immigration and this kind of thing that they get on the health. The number one issue for Labor today is the Employee Free Choice Act, to permit them to have card check-offs for organizing. That’s really the most powerful, although you still—this is one of the four or five issues that they’ll list, but they’ve got other issues as well. In a number of areas there is a heightened interest on the part of Labor, because in an increasing number of these negotiations they are losing ground because they are having to pay higher co-pays and higher deductibles. Therefore, it’s becoming more of an issue at the bargaining table, where it was sort off the bargaining table for years. Even in the UAW, it was never—all they would do is continue to make progress in coverage, and now they’re in a gradual kind of retreat. They made this macro deal recently, where they developed a foundation to offload some of the expenses—a rather complicated financial deal that helped them get out from some of the legacy costs on it. But I’d say that now, in many more union disputes, healthcare is front and center, but they still care about some of these other issues. We could go on in terms of where we are in the ’70s. We’ve gone through pretty much on Nixon."

"The other part of Labor said that they don’t want any part of this program for universal coverage, because they want to be able to deliver it as part of their organizing. They want to be able to go out and say, “Join my union because we’re going to give you health insurance.” They’re not as interested in universal coverage, because that’s going to take away a major kind of an appeal that they would have. So you had lip service. You had some who were very strongly for it—the industrial unions; others who said they were for it and really were not; and others who basically sat on their hands because they said, “Why are we going along with this Kennedy proposal when we can use this as an organizing tool? We’re losing members, and we’re losing support in terms of working—this is a key way of getting it. It’s got a lot of grassroots support, and we use it as an organizing tool.” Of course they didn’t use it as an organizing tool. They didn’t do the follow-up on it. Andy Biemiller and [George] Meany and the other follow-on leaders were not interested really, in following Lane Kirkland. Lane Kirkland was more interested in the international Labor movement. I mean, he was somewhat interested in solidarity. He did do some good work in terms of the support of international, but he wasn’t really interested in this. We had a hard time keeping all of that moving."

"Well, it really never came enough together, because when Labor sort of took a walk on this, that was a setback. I thought we still might be able to get it pulled together with the Republicans and enough Democrats on it, although Labor was teed-off at it. There was some division within the Labor movement on it. You know, it was always very interesting with Labor, because there was a great dichotomy. You had industrial unions that wanted it, because a third of all of their premiums that are paid are being used to cover somebody else. So those are lost wages. They understand that their economic interest is in getting universal coverage, because then they weren’t going to be picking up and paying for people who didn’t have it. So that made sense. They were going to increase their wages and have a stronger position, and it was sort of the right thing to do for other workers. They liked it. That’s one part of it."

"We had conversations with Mel Laird about how we were going to proceed. He had basically the concept of pay-or-play, which we would grab today if we had that opportunity, which meant that you either have an insurance program for your people or you pay into a fund. That concept is used in Europe in their industry, not only for health but also for training programs. They have training programs with the requirement that you either have to train a certain percentage of your workers in a continuing training program, or you have to pay into a fund that will continue to train them, and so you have an ongoing and continuing training program. That was what we called the school-to-work program, which we actually implemented here during the [William] Clinton Administration. But the only way we could get it passed was if we sunsetted it, and we sunsetted it, and the Republicans wouldn’t vote to continue it, which was a good program. Now we’re into the ’70s, where Nixon gets impeached, and so that whole effort collapses."

"When we went with Wilbur Mills, they thought, in the ’74 period, ’76 period, that they were going to have a veto-proof Congress. They said, “Why are we making accommodations and adjustments now to try and get a bill, when we can wait, and we’re going to pick up all kinds of seats in the House and the Senate, have a veto-proof, and therefore, we’ll be able to get a much better bill?” It’s always the classic kind of circumstances, where you’re holding out for the perfect, rather than dealing with the good. This was the first example. The next example—and we may not want to get ahead of ourselves—was during the period where [Richard] Nixon was just getting started on Watergate, and getting impeached—the process of threatening for the impeachment. Mel [Melvin R.] Laird, who was very close to President Nixon, and had also been on the Ways and Means Committee or Appropriations Committee, was a very smart person and had talked to Nixon. They believed that if this was such a powerful issue and one with such popularity, that it might even save Nixon from impeachment."

"Now we’re into the period of the ’70s, and we’re trying to think about how to go through—We go through a whole series of different maneuvers over a very considerable period of time. We’re trying to see how we can build a coalition and how we can expand the breadth of our support. One interesting phenomenon during this period of time is that Wilbur Mills, who was the Chairman of the Ways and Means Committee, an enormously powerful position, was interested in running for President. No one gave him much of a chance, but he thought that the way to do it was to be for national health insurance, and so this opened up—To have the Chairman of the Ways and Means Committee being your ally on this was a very significant and important opportunity. He and I got along fine. I had never been all that close to him, but he respected my brother Jack, and they had some mutual friends. So we had this sort of dance, trying to get him into the program. He wouldn’t go for the single-payer program and through all of this period, we’re sort of adjusting and changing. The Republicans, even when they came our way later on, were always sort of holding back and always tipping the tide to the industry—and the industries that were most effective were the insurance industries and hospitals—during the series of debates. We suffered a very serious setback as we started to move ahead in the early ’70s, with the loss of—Walter Reuther was killed in an airplane crash. And also by the fact that Wilbur Mills got himself in trouble."

"So, we had Reuther, and I was able to get a number of people who were co-sponsors of it, Democrats, and only one Republican. The one Republican was John Sherman Cooper, who was not a liberal Republican. I never could quite understand what that was really all about. I was a great pal of John Cooper. He was closest to my brother Jack, and a dear, dear, valued friend in the Senate. I’ve told the stories about John Cooper and the respect people had for him. But when we put in the bill the first time, we had one Republican and it was John Sherman Cooper. People sort of gasped. On the Democratic side, we had a good chunk—I don’t know, probably 30 to 35 Senators on there and we were on our way. I put it in with a Congressman who was on the Ways and Means Committee, Jim Corman, who was a very bright, smart person, who had worked with Reuther and had been for comprehensive, single-payer. This is basically the single-payer program."

"I was aware of Harry Truman’s ’48 effort to try to get universal health care, and his disappointment, and that at least [[Franklin D. Roosevelt|[Franklin D.] Roosevelt]] had looked at it in the ’30s and decided to go with Social Security rather than the health issue, and that it went back to Teddy Roosevelt’s progressive period, where he tried to move it along. So I knew the concept of the issue of national health insurance. I had heard enough, having been in the Senate during the ’64 battle, and in ’65, to know that we had taken a chunk of this but we hadn’t done the whole job. I had seen the success that they had had in ’64 and ’65 and thought that this was both a great opportunity and an area of very important need."

"That was the time of Walter Reuther, whom I had known from the time he had been supporting my brother. He was very significant and a major figure, and highly regarded and respected. The UAW [United Auto Workers] had been a union that had supported my brothers, as well, so there was a good association with that. In a meeting up in Boston—and I don’t remember who had set this up, probably one of our supporters from the UAW set it up in Boston at one of the hotels—I had an extensive meeting with Walter Reuther about their proposals for developing a national health insurance movement. Would I be willing to be involved, active and help lead it? That sounded like a great opportunity to me. They had demonstrated both effectiveness and commitment, and this was something that was enormously important, and could make a large difference. We were coming out of the period of the mid ’60s, where we had passed Medicare, in ’64 or ’65. We actually completed it in ’65, but there had been discussion, even in the Medicare, that this was only a part of the whole movement of comprehensive coverage."

"The way the system works, obviously, is whoever is the senior one gets the choice of the different committees. It appeared to me that Claiborne Pell was going to take the Health Committee and I was going to be on the Education Committee. I liked Senator Pell. I had been in the Senate for five years, and although that sounds like a long time, in time of the Senate it was a short time, and I’d been out a good chunk of that time because of the plane crash in ’64—I’d spent’64 out of it, and ’63 was a difficult year. Then we had the ’68 campaign and that was a difficult year as well. But now, in ’69, we’re looking at both the committees and where I’m going to spend time and how I can be the most useful and productive."

"There are ways of trying to undermine that, which the opposition is very clever at. I find that the arguments are old and they’re tired, but they still have a ring to them: the idea that you’re going to have a bureaucrat in every hospital who will be making medical decisions, the idea that hospitals will close, that doctors will leave, that the expenses will go on up through the roof, that you’ll have socialized medicine. All of these features can be manipulated in ways that can impact and affect people’s fundamental decency."

"A continuing aspect is that people are very fair, and they’re rather empathetic and sympathetic about their neighbors. This is something that they understand and they feel, and they appreciate. The question—you can continue to say, “Well, they may feel that, but if they’re going to be up against the wall and have to pay another big chunk of change, how long are they going to feel it?” I think there’s that kind of issue and question, and if the negative aspects are presented to them, in a way, they’ll be influenced by that as well. The idea of fairness in this country still has a ring to it that’s sort of overwhelming, such as when you’re talking about increasing the minimum wage, even among people who all do better than that. People understand it and they’re empathetic and go for it. People understand this. And what’s interesting is that every family knows somebody who has had the circumstances that I’ve talked about, and they feel strongly about it. They are wary."

"So this aspect of health and the coverage and the rest of the policy issues are all rooted in a very early association and personal attachment. Finally, the policy issues come and attach themselves in different ways, and we can talk about that. You can talk about how people who have a preexisting condition—Even Teddy, who has had cancer—even though he’s 47 years old, he could not get an individual insurance policy today, because he’s had cancer, even though he’s as healthy and strong as can be. He could not go out and buy, in the United States, an individual policy. That’s the way it is. That’s the way the system works on this. Obviously, he’s in a group—but then, if he left that group, could he still carry on through? You didn’t used to be able to, but you’ve got the [Nancy] Kassebaum bill now that says that they can’t discriminate against—if he’s gotten into the system, they can’t knock him out. But that’s sort of a feature of the policy. We can go back now to a time when we got started in the health policy issues, but I think it’s at least of some importance and consequence how we got into it."

"And they are just as much out there today. You could have that same hearing today in Chicago and you could have it in any city in America, and have the exact same results on it, and that part has even grown, because you’ve got so many more—I mean, I use the example of the parents that hear a child cry in the night and wonder whether they are $485 sick, because that’s what it costs to go to an emergency room. They listen to the child. Is the child getting better or sicker? They wait until the child finally goes to sleep and wonder whether the child is going to be worse in the morning, because they can’t afford the $500. Or they take that $500 that they put aside to educate their kids, and it’s gone. And that is what’s happening all across the country."

"You had this dramatic contrast between the system that was just wringing the last ounce of humanity out of a family, and this other system that was dealing with it in a humane and decent way, and a more economic way in terms of the whole process. I mean that was just one—I can remember it just as clearly as I’m here. You know, these things don’t leave you."

"Then—this was very interesting—in Canada, the family with the spina bifida child, and they were taking care of it. While the mother had the spina bifida child, she had a family of four: three of them had graduated from high school and were out. She had one left, and she went and adopted three children who were disabled, and the governmental system paid for taking care of them—the food and the clothing and a stipend for the housing. You’d ask the mother why she took in these children and the mother’s response was, "I want to teach this child what love is all about.""

"One of the most dramatic that I still remember so clearly was in Chicago. It was two families that had children who had spina bifida. In the U.S. family the mother was a schoolteacher and the husband was a construction worker, and they made a good chunk of change and had a very good life. There was one other child in the family. Then the mother had to stop teaching school to take care of the child because it got sicker and sicker. And then, because the mother got run down, the husband quit his job. They went through all their savings looking after this child, and the result was that the state was going to take away the child because the parents could no longer take care of this child. You had the mother and the father completely distraught about this. This was out in Chicago."

"I spent six months in the hospital and five months in a Stryker frame—six months in all—when my back was broken, and I saw the dedication of the people. I knew it was costing a chunk of change for the insurance companies to cover my health insurance on it, but it didn’t present itself—the starkness, the compelling aspects—about the pocketbook. And that has never left me. That aspect of it I’ve been constantly exposed to in the time that I’ve been in the United States Senate, and I go back to it on many different occasions, on the different hearings or things that follow this. One very important set of hearings that I had in the Senate were the hearings in the—We’re getting ahead a little bit but it’s probably worthwhile pointing out because it’s close to this subject matter. In ’78, when we took the committee across the country, we tried to match up, in the hearing, the panel that we’d have. We’d have one panel and we’d have probably ten witnesses, but we’d group them so that there were five subject matters. We would have the way that the United States covered the particular illness, and the way the Canadians covered it, just to present to the American people the difference, you know, how the systems were in terms of real life circumstances. We’d have what were common experiences in the particular areas that families would be affected."

"At the time that we were debating family and medical leave, these families would lose their jobs if they didn’t show up, let alone get paid for it, you know? They would either lose their job for not showing up, or at least lose their pay, because they didn’t have the kind of coverage that we had in the United States Senate. That was at the same time that we were debating the family medical leave, and here you had about the most stark—the decision that parents have to make about whether to be with a child or—to have the job that they need, or the job that they love. I didn’t use the example of Teddy, really, during the debate, until the very end, during the final windup. After President [[George H. W. Bush|[George H.W.] Bush]] I vetoed it in 1992, I sort of pulled out the stops on it."

"This was a very powerful presentation, in terms of starkness, about health and health insurance and coverage, and basically the moral issue presented here. We were all in the same circumstance. This is a very rare disease that could have happened to anybody. It happened to a United States Senator; it happened to children of working families. There was nothing that they could do about it, and they were being put through this kind of system. This is about as stark as you can get, in terms of the compelling aspects of this issue. A secondary issue that came up that’s related to the public policy is family and medical leave. I’d have to leave the Senate on Friday, and I could go and tell Mike Mansfield that I wasn’t going to be there. Just in terms of the votes, I wasn’t going to be there. It wasn’t a question about me not—I should be with my son and I was going to be with him, but I wasn’t going to lose my job because I was leaving, and I was getting paid for it while I was gone. I was getting paid leave on this."

"Experimental research basis by the NIH. There were probably less than a hundred that had gone through it, but they had had positive numbers on that. Before that, it was very tough; the survival rate was not good, you know, 15 to 20 percent. But after this it was 85 or 90 percent. So that was enormously encouraging. After about three months of my being involved in it, they had completed the whole regime for it. While it’s an experimental drug, it’s paid for by the company or whoever is producing it. But once it’s stopped, the payment stops, and these families had to pick it up. Since it’s an experiment, none of the insurance would cover it, except mine, which is Senate insurance, federal employees’ insurance. The cost is $2,700 a treatment. These parents would be in the waiting room—they had sold their house for $20,000 or $30,000, or mortgaged it completely, eating up all their savings, and they could only fund their treatment for six months, or eight months, or a year—and they were asking the doctor what chance their child had if they could only do half the treatment. Did they have a 50 percent chance of survival? A 60 percent chance of survival?"

"After we made a judgment about which regime we were going to follow—there had been several recommendations, and we spent hours trying to make a decision. What was interesting was that there were alternative ways of proceeding, and when the final decision was made, which I made, those who had different regimes were all very supportive. There was a real coming together of people who were all looking for a common resolution and solution to the challenges they were involved in. They all had different pathways, but nonetheless, once the judgment was made, they all were incredibly supportive. It required that Teddy spend three days every three weeks at the Children’s Hospital in Boston, taking methotrexate, which is a medication that helps kill cancer cells, and this other medication [citrovorum] that helps to alleviate some of the adverse effects of methotrexate. That involved me giving him shots, which I did, both before he came on up to Boston and then right after he had finished the immediate treatment—for the next couple of days intensively, and in the night a couple of times, and then periodically, every four or five days after that."

"I was exposed to the most extraordinary groups of doctors and nurses at the Lahey Clinic. Dr. [Herbert] Adams, who was the head doctor up there—there may have been a day when he didn’t come in and see me, but I don’t remember it. This included Christmas Day, New Year’s Day, the whole time I was up there. The commitment and the dedication of the doctors and the nurses, and the support systems and the professionals, was just breathtaking. I think it probably led me to the very strong commitment that I’ve always had, politically, to strong support for nurses, for support personnel, because I always recognized their indispensable role. The doctors, yes, but the support personnel for their patience and their time. During the period when Teddy—Now we’re probably into ’74, so we’ll have to come back to how this intersected with the policy judgments and decisions. It was all within a few years of each other—the dramatic time that I had in the Dana-Farber Institute in Boston with my son Teddy. He had a treatment and we found out that he had this leg cancer that required the loss of his leg, and that’s a special circumstance that we can get into."

"So healthcare was something that had a real powerful impact. Also, in 1962, I remember the incident when my brother lost a baby to hyaline membrane disease. The child lived three days and then died at the Children’s Hospital in Boston. The interesting factor and force of all of this is that, if the child had been born two years later, it would have survived. The progress that was made in medical research would have permitted the child to survive. Here was the person who was the President of the United States, with all of the assets that he could have, and still was unable to see a positive outcome of this. Within all of that, financial security was certainly present. It was present also in 1964 when I had the plane crash we’ve described earlier. I was able to get medical attention, initially up at the Cooley Dickenson Hospital, and then later at the Lahey Clinic that was located in Boston, before it moved down outside of Boston in later years."

"Later, in the early ’70s, we were faced with the health challenges that Teddy was facing with cancer of the leg. I always thought it was osteosarcoma, but I’ve been told it may have been chondrosarcoma. I remember very clearly his talking about and complaining about a bump on his leg, and how it wasn’t getting any better and it was getting sorer. One morning I was headed to Boston and I was getting briefed about the various health meetings I was having in Boston. One of the staff people, Phil Caper, was also a doctor, and I had mentioned to Phil about the swelling. He examined Teddy and said, “You’ve got to get an X-ray on it right away.” I remember hearing later in the morning when I was up in Boston, about how they looked at the X-ray and saw the cancer, and that this was just enormously serious—life threatening. It was going to take immediate and dramatic action, which presented a wide range of both emotional and real decisions about the removal of his leg—the conversation prior to that time and the conversation after that time. At the same time, my niece was getting married, Kathleen [Kennedy]. So this was a very emotional, roller-coaster period in my life. And then much later, my daughter Kara [Kennedy] found out that she had lung cancer. That was as a result of a picture that had been taken of her lung after—She had pain in her shoulder and was under medical attention for stenosis, and the very good doctor suggested that they take a picture of the shoulder. They found that she had lung cancer, and we had to move within a matter of hours. We went, later that afternoon, up to Johns Hopkins and had discussions up there with their medical team, which were very unsatisfactory. Then we had medical consultations with some experts and made a decision to follow a different route, which was surgery, which has worked out very successfully. She’s now four or five years free from any cancer."

"When Patrick developed it, we brought in medical experts at least once a year and sometimes twice a year, from around the country. They came in at nighttime. They would examine Patrick and talk with him, and then they would go off by themselves and have a meeting at a hotel, and then they would come over in the morning and brief me on their understanding of his condition, and their recommendations. Since he was chronic, there was a whole series of different types of medications that they would talk about, and the advantages and disadvantages of each. That continued all the way up through his graduation from Andover, even in his last year at Andover. The last meeting was at the Parker House in Boston. He had some time off and my son [Edward M. Kennedy, Jr.] Teddy was going to take some time off, so the three of us were going to go away, and the doctor said, "Don’t go further than 35 or 40 minutes from a hospital." So we went down to Key Biscayne, because we were 35 minutes away from the hospitals down in Miami. So, it was a major factor and a force as he was growing."

"I was elected to the Senate, and in the early years as my family arrived I was exposed to the power of asthma with a small child, Patrick [Kennedy]. We detected when he was two that he was a chronic asthmatic. He had the test that is given to children, where they have pinpricks along their arm—I think it’s 24 pinpricks—of different kinds of allergies. His arm looked like a nuclear meltdown; it just absolutely reddened, all of it. He was allergic to everything. My brother Jack [John F.] Kennedy was allergic to cat fur and my sister Pat [Patricia Kennedy Lawford] had allergies, and maybe the others had some, but I certainly noticed those as they were growing up. My brother Jack would come back to the Cape and would go into his room, and he’d come out about an hour later, storming mad, wondering who let the cat sleep in the bed while he had been away, or some cat had come on in. He’d be battling the allergies for the next several hours."