Mitt & Ted, a healthcare story

NARRATION: Part One: My Greatest Regret.

MUSIC: Enter

Barbara Souliotis: I think it started when his son, got cancer And that was, that was really a turning point I think.

NARRATION: In late 1973, Senator Ted Kennedy was faced with what he later called "the hardest thing I ever had to do": telling his son he had bone cancer, that it was serious, that they would have to amputate his leg.

Ted Jr. was twelve years old, and for a time, the child was quiet. He put a towel over his face so no one could see him, while his father, who was usually so full of life, so full of energy, simply held the kid in his arms and said over and over again that everything would be OK. Eventually the phone in the hospital room rang; it was the President of the United States, Richard Nixon. The Senator picked up, then handed the phone to his son so the president could wish him well before the operation.

At 8:30 the following morning, the doctor removed Ted Jr.'s leg.

It also happened to be the day that Bobby Kennedy's oldest daughter was getting married. And Ted, as the last of the Kennedy brothers still alive, had to be there to walk his niece down the aisle. Just think about that: leaving your son's hospital bed, to go walk your murdered brother's daughter down the aisle at her wedding...

Ted went straight from the hospital to the church, and back to the hospital; he never changed his suit.

MUSIC: Out

NARRATION: A few months later, in early 1974, Ted Jr. began his chemotherapy treatment at Boston Children's Hospital. He was not out of the woods yet.

Barbara Souliotis: And he had to have, experimental treatment every three weeks for three days and the senator flew up. For every one of those treatments. Stayed in the hospital with him.

NARRATION: Barbara Souliotis ran Kennedy's Boston office, so she would see the Senator on these trips, as he anxiously watched his son Teddy Jr. suffer through nausea, fever, terrible pain. Waiting to see if the treatment would work.

Ted Kennedy: this was on an experimental, experimental research basis. This is an experimental research

NARRATION: Ted Kennedy himself described this period in an oral history interview a few years before he died. And he remembered how at first, this experimental treatment was completely free.

Ted Kennedy: While it's an experiment it's paid for by the, the company

NARRATION: But then a few months into the program, the clinical experiment ended. The good news was that the results were extremely promising: a 90% survival rate for a condition that used to have more like a 20% survival rate -- truly the difference between life and death.

Ted Kennedy: So that was enormously encouraging.

NARRATION: The bad news was that the families would now have to pay for it.

Ted Kennedy: and it's $2,700 a treatment is what it cost. And none of the insurance would cover it except mine.

MUSIC: Transition

NARRATION: In this hospital, Teddy Jr. was one of the lucky ones. His father had US government health insurance, the kind all congresspeople get. So Teddy Jr. could keep coming back every three weeks, receiving the shots, waiting for this new wonder drug to do its work. Ted Sr. would wait there too.

Barbara Souliotis: And when Teddy was sleeping. He would walk the car and talk to parents who had children in there who, uh, couldn't pay for the treatments. Some had to mortgage their houses, basically Go bankrupt 'cause they had no health insurance.

NARRATION: Kennedy remembered these families tallying up all their savings, all their assets, to see if it would cover even just a few more months of treatment, and hoping that would be enough to save their child's life.

Barbara Souliotis: And they, they would ask him, what if we can only do one treatment? You know, would that help their kid. Just because they couldn't afford it, And he said that he, and that's what he said, this shouldn't not be happening in this country.

MUSIC: Enter

NARRATION: Walking the corridors of that cancer ward, Ted Kennedy fully embraced what became the cause of his life: universal health insurance. He knew it was a complicated and elusive issue -- he wasn't naive -- but he couldn't possibly know just how hard it would be, how long he would have to fight.

ARCHIVAL: The issue before the American people isn't, can we afford national health insurance? Is can we afford not to have it?

NARRATION: Through the 70s, the 80s, the 90s, the 2000s

ARCHIVAL: Comprehensive, universal,

health insurance

every child in America and every adult too.

NARRATION: On the senate floor, on convention stages, in forums and townhalls around the country -- Kennedy voiced the outrage he felt in that hospital ward.

ARCHIVAL: It is a national disgrace

NARRATION: This was the issue Kennedy just kept coming back to again and again over his nearly fifty year career in the US Senate. Because even for one of the greatest dealmakers that chamber has ever known…this was the issue that just kept on eluding him…

ARCHIVAL: The cause endures. The hope still lives, and the dream shall never die.

NARRATION: Something I've come to appreciate about politics in America, is that there are windows of opportunity in which major change can happen. I’m talking about change on the scale of the Social Security Act, or Civil Rights Act – laws that redefine what it means to be a

citizen of the nation. These windows of opportunity are like celestial events, far beyond the control of any one individual -- even an individual as powerful as Ted Kennedy. They are the rare moments when public sentiment, political power, pent up frustration -- the perfect mix of personalities and incentives -- all these things click into alignment to open up a door. And when the door opens, everyone has to be ready to rush through it.

MUSIC: Out

NARRATION: But the tragic irony of Kennedy’s nearly 40-year health care crusade is that his first and best opportunity to make it happen -- came too soon, before he was ready. This opening came without warning, even as his son was lying in that cancer ward. In 1974. And it came from Nixon himself.

ARCHIVAL: Mr. Speaker, The president. Of the United States.

NARRATION: When Richard Nixon rose to give his State of the Union address in January of 1974, he was speaking as a man desperate to change the subject: anything but Watergate.

And the subject he chose was health care.

ARCHIVAL: Turning now to the rest of the agenda for 1974. The time is at hand this year to bring comprehensive, high quality healthcare within the reach of every American.

Stuart Altman: He didn't wanna call it national health insurance. We had to call it universal healthcare.

NARRATION: Stuart Altman was a staffer in the Nixon administration, and he basically wrote the President’s health plan, specifically for this speech.

Stuart Altman: I never had so much power and it was around Christmas time. 'cause I remember saying to others, including my wife, don't count on me for Christmas.

NARRATION: The final plan included measures that today would seem wildly progressive… especially for a Republican president. Like a mandate on all employers to either provide health insurance to their workers, or pay a penalty. Again: that’s a government mandate on businesses to provide health insurance. That is what Nixon himself proposed in 1974.

Stuart Altman: A real serious national health reform plan.

ARCHIVAL: Comprehensive health insurance protection to millions of Americans who cannot now obtain it or afford it

NARRATION: So you might think Ted Kennedy would be over the moon - a Republican president talking about universal health care. But for Kennedy at that time, Nixon’s plan just didn’t go far enough. And when you watch the footage of the 1974 State of the Union, there’s a moment where you can see this tension play out.

Right as Nixon makes his case for universal health care, the camera cuts to Ted Kennedy out in the chamber. He’is leaning back comfortably, with a wide checkered tie, and that strong Kennedy chin jutting straight. His eyes are locked on Nixon.

But when the congresspeople around him burst out in applause, he just sits there.

Because laced into Nixon's grand vision, was also a not so subtle critique.

ARCHIVAL: Now, I recognize that other plans have been put forward.

NARRATION: You should know that even before his son’s cancer, Kennedy was already a leading voice on health issues, and just the year before he had put forward his own sweeping health reform bill.

It would have created a true national health insurance system, European-style, run by the government – what gets called ‘single payer’ or ‘Medicare-for-all’.

ARCHIVAL: That would put our whole healthcare system under the heavy hand of the federal government.

NARRATION: Nixon was clearly not ready to go that far, but in 1974, desperate for anything that could change the course of his doomed presidency, he was willing to go pretty far -- farther than many of his own advisors wanted him to go, and farther than any other Republican president in recent memory.

In the closing lines of his speech, Nixon explicitly asked the Congress to work with him. To put the chaos of Watergate aside and do something together that they could never do on their own.

In that moment, the celestial alignment I talked about started to come into view -- that narrow path forward. The question was, would Kennedy join Nixon on that path?

MUSIC: Enter

ARCHIVAL: We can and we will make the year 1974 a year of unprecedented progress and a new prosperity without war in the United States of America.

MUSIC: Out

NARRATION: Kennedy saw Nixon's bill as a half-measure, at best. A tweak to the system that rewarded the private insurance companies. At worst, Nixon's bill was a threat, something that could suck energy away from true, meaningful reform.

ARCHIVAL: What does this mean for your bill? Well, first of all, we have to understand that

NARRATION: So politically speaking, Kennedy had plenty of reasons to deny Nixon's invitation, and stick with his own bill.

NARRATION: But then in April, so a couple months after the State of the Union, Ted Kennedy surprised everyone. He linked up with the most powerful Congressman in the House -- the chair of Ways and Means Committee -- and together they say: we’re willing to work with Nixon’s plan.

Stuart Altman: And they announce we would like to work with the administration and the president to pass this legislation right away.

ARCHIVAL: we're going to build upon the existing strengths of our system,

Stuart Altman: which just sent. Signals all over the place.

MUSIC: Enter

Stuart Altman: Front pages of the New York Times and the Washington Post, and we're gonna have national health insurance.

Ian Coss: It seemed like a done deal at that point.

Stuart Altman: Absolutely.

ARCHIVAL: the issue of national Health has been, uh, before this country for many years, almost since the turn of the century.

NARRATION: That spring Kennedy himself told reporters: "A new spirit of compromise is in the air."

Stuart Altman: Wow, you know, The president, the most powerful senator, all agree.

ARCHIVAL: And now all we have to do is find the cure.

MUSIC: Post

NARRATION:  But the challenge wasn't just Kennedy and Nixon themselves. It was also their more hardline allies who didn't want them talking in the first place. On the right the pressure came from Nixon's own cabinet, who again, were not on board with the plan he had just proposed to Congress.

Stuart Altman: And they were all screaming at him, we just read this thing This is socialism, what have you done?

NARRATION: Meanwhile on the left, the pressure came primarily from organized labor.

Stuart Altman: From the unions and from liberal groups saying, what are you doing?

NARRATION: Remember, Nixon was wounded at this point. Impeachment hearings were about to begin. He was fighting for his political survival. And you want to throw this guy a line? You want to work with his plan?

MUSIC: Out

NARRATION: With all this pressure building, Kennedy decided to call a meeting with leaders from the United Auto Workers and AFL-CIO, to try and bring them along.

The tricky part of this is that for many working people, getting health insurance was a big part of the reason to join a union, and support your union. So for the big labor groups, any kind of health reform wa bound to be a sensitive issue.

MUSIC: Fade in

NARRATION: Now those labor leaders were in Kennedy’s office – a whole group of them – and they were furious. The way they saw it: Democrats would probably win a landslide in that year's mid-terms. They could soon have majorities in both houses; Nixon could be gone entirely. And that would be the time to pursue true reform. Not this hodge podge compromise Nixon was offering.

Kennedy began fuming, and he grabbed a copy of the Congressional Directory and just started reading out the names of all the senators who would never support anything like a single-payer plan, asking again and again: "What are you going to do about him?" And him?

Finally, one of the top lobbyists in the room hurled back an almost unthinkable insult, which was also a threat. He said to Ted Kennedy, you are quote: a "traitor to labor," for even entertaining a deal with Nixon. At that, Kennedy stood and opened the door for his guests to leave, saying "Well you’re just going to have to call me a traitor.”

MUSIC: Enter

NARRATION: What Kennedy understood was that desperation -- Nixon's desperation -- could be the key ingredient for deal making. It forced him to do something instead of nothing. But the negotiations would have to go underground.

Stuart Altman: So we formed a secret work group

MUSIC: Shift

NARRATION: One day in June of 1974, Stuart Altman took a short cab ride to the corner of Third Street and A Street: Saint Mark's Episcopal Church. He paused for a moment to glance around and make sure no one was on the street who might recognize him. Then he stepped through a side door of the church, and down a steep flight of stairs, to a room known as 'The Pub.'

Stuart Altman: They actually at night served beer

NARRATION: Remember, Altman was one of Nixon's health aids. And there waiting for him in the empty pub, was a top health aid for Ted Kennedy. Given the level of tension between these two men and the forces pushing them apart, this was like sending a secret envoy to the Soviet Union.

Stuart Altman: We met in the basement, to not have all these people down on her throats.

NARRATION: So the two aids got to work, trying to hone in on that acceptable balance of government control and free competition.

Stuart Altman: To see if we could find common ground.

But outside that church basement, the time for a deal was running out.

ARCHIVAL: Mr. Butterfield, are you aware of the installation of any listening devices in the Oval Office of the president?

NARRATION: Watergate was now a national obsession. Formal impeachment hearings were underway in the House, and broadcast straight into American living rooms.

ARCHIVAL: Those who wanted seats had waited through the night on expectations.

NARRATION: The story was everywhere; all consuming.

ARCHIVAL: And so there is tonight a real persistent and substantial question of whether the president can in fact carry out his responsibilities.

MUSIC: Post

NARRATION: Somehow, the secret church meetings continued through June and into July, with the two sides inching ever closer together on a health care bill. Even as Ted Jr. received his cancer treatment and began to recover. Even as Nixon's Oval Office tapes were handed over to prosecutors, and the impeachment hearings accelerated – down at St. Marks they were talking about payroll taxes and insurance rules. Because Altman and others could still see the historic opportunity -- the narrow opening before them.

Stuart Altman: You are never gonna see anything more liberal than this, This is the best health insurance plan you're ever gonna get. I said, we gotta get this done.

MUSIC: Out

NARRATION: As late as July 8th, 1974, – one month before Nixon’s resignation – Kennedy was still on the phone with Nixon's Health Secretary, who was still telling him: a deal is possible. If you get it to his desk, Nixon will sign it. But soon after that call, Kennedy sat down with his top aid -- the one in those basement negotiations -- and they truly took stock. It was a tough situation. Kennedy was looking at how much ground he had given up already, how far there was still to go, and how fiercely his own allies were trying to pull him back. He said to his aid:: "they're ready to crucify me out there."

For Kennedy, it ended quietly -- there simply was no next meeting, no next phone call. He just, let it go.

MUSIC: Transition

ARCHIVAL: Good evening. This is the 37th time I have spoken to you from this office

NARRATION: On August 8th, Nixon addressed the nation directly. This was more than two years after a group of burglars was arrested at the Watergate Hotel, and finally the never ending drama was over. Nixon was resigning.

ARCHIVAL: As I recall, the high hopes for America with which we began this second term, I feel a great sadness that I will not be here in this office. Working on your behalf to achieve those hopes in the next two and a half years. May God's grace be with you in all the days ahead.

NARRATION: That day in August of 1974 a doorway closed, and it stayed closed for a long time.

Stuart Altman: Health insurance, went kaput, it just disappeared.

Ian Coss: How did, Ted Kennedy reflect back on the summer of 1974?

Stuart Altman: I got to meet him And he said several times I thought we were gonna do it, Stuart. I thought we were gonna make it. I'm I, , We should have done it. We should have get it done.

NARRATION: Kennedy said many years later in a speech, "to every cause, there is a moment." But how can you know it's the moment when you're in it? How could Kennedy have known that he would never again get an opportunity this good, a chance to pass something so ambitious? How could he have known that after Watergate, trust in government would only fall? That the appetite for new government programs would only shrink? And that with time, bipartisanship itself would only get weaker?

How could Kennedy have known he would spend the next thirty years fighting tooth and nail to get even close to what Nixon was offering? Of course, he couldn't. Kennedy would say many times, that failing to seize that opportunity with Nixon was the greatest regret of his political life.

Barbara Souliotis: Several years later he said, we should have jumped the mat

NARRATION: He told Barbara Souliotis the same thing: it haunted him.

Barbara Souliotis: He just regretted that he couldn't get it done.

MUSIC: Enter

NARRATION: But Ted Kennedy -- over his long career in politics -- would get another shot at his dream. A moment when the planets once again aligned, when an unlikely partner once again reached out, and when Kennedy would once again have to choose whether to make a deal.

MUSIC: Theme

NARRATION: My name is Ian Coss, welcome to The Big Dig, Season 4. It's the story of that second shot. The one Kennedy would not miss; the one that would transform American health care forever. And no, I'm not talking about Obamacare – at least, not quite yet. I'm talking about a little state-wide health care bill here in Massachusetts that was the template and inspiration for Obamacare. To me, this is one of the great undertold stories in our health care debate today. I mean, where did the actual ideas in the Affordable Care Act come from? Why was that the moment they exploded onto the national stage? And why did they become so deeply deeply divisive? Follow those questions far enough, and you will find yourself, like me, in Massachusetts.

In Part Two: Ted Kennedy meets his new negotiating partner, and not on the best of terms. His name, is Mitt Romney.

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The Big Dig is produced by Isabel Hibbard and myself, Ian Coss. It’s edited by Lacy Roberts. The editorial supervisor is Azita Ghahramani with support from Ryan Alderman. And the Executive Producer is Devin Maverick Robins. If you want to hear more stories like this produced by the same team, just search for “The Big Dig,” wherever you get your podcasts and you can find at the very least seasons 1, 2, 3 and now 4. 

Archival sound for this episode came from The Richard Nixon Presidential Library and Museum and The Miller Center at the University of Virginia.

The artwork is by Bill Miller. Our closing song is “Things Will Be Different,” by The Shods. The Big Dig is a production of GBH News and distributed by PRX.