Ted Kennedy’s Legacy, and the Nixon Healthcare Deal That Wasn’t
Phoenix Woman wrote yesterday (actually, twice) about the emerging Village contention that, why, of course Ted Kennedy would have swiftly and gleefully traded away the public option to pass something that could be called healthcare reform legislation, however useless the end result might be.
The latest attempt to make this leaden trial balloon fly comes from columnist Steven Pearlstein in this morning’s Washington Post:
Asked about his greatest regret as a legislator, Ted Kennedy would usually cite his refusal to cut a deal with Richard Nixon on health care.
. . . [in 1971], Nixon asked Congress to require for the first time that all companies provide a health plan for their employees, with federal subsidies for low-income workers. Nixon was particularly intrigued by a new idea called health maintenance organizations, which held the promise of providing high-quality care at lower prices by relying on salaried physicians to manage and coordinate patient care.
At first, Kennedy rejected Nixon’s proposal as nothing more than a bonanza for the insurance industry that would create a two-class system of health care in America. But after Nixon won reelection, Kennedy began a series of secret negotiations with the White House that almost led to a public agreement. In the end, Nixon backed out after receiving pressure from small-business owners and the American Medical Association. And Kennedy himself decided to back off after receiving heavy pressure from labor leaders, who urged him to hold out for a single-payer system once Democrats recaptured the White House in the wake of the Watergate scandal.
Thirty-five year later, the single-payer dream of Democratic liberals still remains politically out of reach . . .
The simple lesson from this story — and certainly the one Kennedy himself drew — is that when it comes to historic breakthroughs in social policy, make the best deal you can get, leaving it to subsequent generations to perfect.
But not so fast. As anyone who saw Sicko might remember, what Pearlstein describes as Kennedy’s initial reaction was, in fact, an entirely accurate assessment of Nixon’s motivation in promoting HMOs — as confirmed by a taped conversation between Tricky Dick and aide John Ehrlichman (transcript condensed to remove cross-talk):
Nixon: “. . . You know, I’m not too keen on any of these damn medical programs.”
Ehrlichman: “This is a private enterprise one.”
President Nixon: “Well, that appeals to me.”
Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. . . . I had Edgar Kaiser come in [and] talk to me about this, and I went into it in some depth. All the incentives are toward less medical care, because the less care they give them, the more money they make.”
President Nixon: “Fine.”
Ehrlichman: “… and the incentives run the right way.”
President Nixon: “Not bad.”
Maybe any deal that a leading Republican politician and his corporate allies would have signed off on in 1971 wouldn’t have been worth agreeing to. Maybe that’s still the case now.