Christopher Jennings Oral History

This is an interview with Chris Jennings. Tell us when you first met Ted Kennedy. What were your impressions of him?

From the very beginning, he was a Senate icon, a healthcare icon. I started in 1983, in the United States Senate, with John Glenn. I recall learning of the tensions, a little bit, between Senator Kennedy and Senator Glenn. Years before, Kennedy had embraced and endorsed Senator [Howard] Metzenbaum over Senator Glenn in a primary, which was hard for Senator Glenn to take, because Senator Glenn was close friends with John F. Kennedy and Robert F. Kennedy. After all, it was Robert Kennedy’s family who asked Senator Glenn to break the news to his children about his assassination. That gives you a sense of how close they were. Glenn ran for President in ’84. That was after Senator Kennedy had decided he was not going to run; 1980 was his last attempt. However, the Senator from Massachusetts who endorsed John Glenn in that election was [Paul] Tsongas, not Kennedy. This gives you a bit of the political context.

I was a young person from Ohio who was in awe of John Glenn and Ted Kennedy. They were the two Senators for whom I knew the most, revered the most, and was most interested. I don’t think I engaged with Senator Kennedy or his staff in any significant way until the [Claude] Pepper Commission, which happened immediately after the demise of the Medicare Catastrophic Coverage Act, which he and my then boss, Senator David Pryor, and many others tried to salvage, but it was a losing cause. One of the few things that survived the repeal of the Medicare Catastrophic Coverage Act in 1989 was the establishment of the Pepper Commission. They passed the Catastrophic Coverage Act in ’88, and I think they repealed it in ’89.

We worked closely with Kennedy’s staff on the Pepper Commission. The Pepper Commission was renamed the Pepper Commission after Claude Pepper died. A number of people wanted David Pryor to become chair, but he would sooner die than to take that post, so he lobbied [Jay] Rockefeller to take it. (It wasn’t a hard task because Jay wanted the position to establish himself as a health leader in his own right and perhaps run for President himself.)

It was an interesting group of healthcare leaders. It was the crème de la crème of the healthcare leadership in the Congress from both sides of the aisle: John Heinz and Dave Durenberger and Ted Kennedy and Jay Rockefeller and David Pryor. There was Pete Stark, Henry Waxman, and Bill Gradison. If you review the history of healthcare, those people were making all the decisions in healthcare out of Washington in those days. Pre-Clinton, the Congress was the hub of virtually all major health reform discussions and work.

There were great hopes for the Pepper Commission, and Senator Kennedy and his staff was quite engaged, though not as intensively as Jay Rockefeller was. At the end of the process, Jay Rockefeller was working to get the votes for the final recommendations of the commission, but he of course did not have to worry about Senator Kennedy on this count (his staff had secured all the policy he needed early on.) Senator Kennedy viewed the Pepper Commission more as a useful tool to jumpstart the legislative process. He’s all about legislating, and when it becomes real, he’ll attempt to take over. It hadn’t yet become real. He would do his best to help create the environment in which it could happen, but there was only so much he could do. All he could do was try to help get a couple of Republican votes or secure all the Democratic votes. As I recall, while he and his staff, David Nexon in particular, were intensively involved in making sure it was as good as it could possibly be in terms of substance—Senator Kennedy went to and actively engaged all the meetings—my recollection is that he was not the focal point of the commission’s work.

That this was not a Kennedy show?

No, it was not a Kennedy show. He was on the Pepper Commission because it was the visible Washington health reform effort—but it wasn’t where the rubber was going to hit the road.

He was there.

To give you a sense of the challenge of health reform, the person Senator Rockefeller had to worry about was Pete Stark. He was angry because Max Baucus—who was also a member of the commission and now as the chairman of the Finance Committee would not agree to commit to support this universal coverage initiative that included a requirement that employers make contributions to healthcare. So David Pryor, who was similarly situated as a pro-small-business guy, was designated by Jay Rockefeller to get Max Baucus to vote for this thing.

What was Baucus’s opposition?

He didn’t want the small-business mandate, so we threw a lot of money/subsidies to small businesses to make healthcare as affordable for small businesses as possible. There would have been a great discount for small businesses to get healthcare, but he was nervous.

Because of election issues?

Yes. He was nervous about NFIB, the National Federation of Independent Business, opposing him. Max Baucus always worried about losing an election, and this was carried over to his work in the commission.

There’s an interesting Kennedy story, a side story to this. David Pryor was historically Mr. NFIB Democrat. He was a small-business guy, but he had agreed to support this with some special protections for small businesses. His job was to get Max Baucus to vote for this, and the Kennedy angle was this: The night before the final vote in the Pepper Commission, after we’d given all these new subsidies and benefits for small businesses, David Pryor went to see Max Baucus. He gave him a book that Max Baucus had given him years before when he had asked David Pryor to cast a similarly tough vote. He handed over the JFK [John Fitzgerald Kennedy] book Profiles in Courage. He said to Max Baucus, “I’m asking you, as a return favor, to vote for this,” and he returned the book. Max Baucus smiled and then committed to voting for it.

We got to the day of the vote, and David Pryor whispered to me, “He’s going to vote for it.” Right before the vote, Max Baucus went to see Jay Rockefeller, and he told him, “I can’t do it. I won’t be able to vote for it.” He changed his mind. You know the rule of the Senate: once you make a commitment to a Senate colleague, you never retract it. It’s a violation of the code. David Pryor was stunned and shocked and crushed. He did a personal favor for Jay Rockefeller to get Max Baucus, and he thought he had delivered, and Max Baucus changed his mind.

We got to the vote, and normally you would go around the room in alphabetical order, but he decided to do it in reverse alphabetical order. There were 15 people voting: Republicans, Democrats, administration appointees. He went in reverse order so that Stark would come before Baucus, because he was worried that if Stark saw Baucus vote against it, Stark would vote against the package. They got to Stark, and he was like, “What’s going on here?” He got really mad, and he passed. He wouldn’t vote.

They went around the circle, and they got to Baucus, and Baucus passed. Then James Balog, who was President [George H. W.] Bush’s appointee, passed. At the end of the first round of the vote, it was 7-5 for, and they had to secure the outstanding votes. Stark was so mad, he voted against it. That made it 7-6. Then Baucus voted against it too, and it got to 7-7. The only vote left was President Bush’s Republican appointee, James Balog, who came from the insurance industry, and he decided, shock among shock, to vote for it, and it passed 8-7. It passed, but it was such a mixed vote that it wasn’t a mandate for support in any way.

Interestingly, we were then kicked out of that room. The Senators were kicked out of the room. It was in the Capitol Hyatt over on New Jersey Avenue. They kicked them out of the room because someone else had reserved the room. Stark was pissed, and Rockefeller was pissed, and Pryor was crushed. I remember, he was so dismayed. Stark went out to the press and just railed against the whole package. He was so mad. He did it even though Rockefeller had begged him not to talk to the press until we finished the voting, because we still had to vote on long-term care. Stark said, “Screw you. I’m going to go do it.”

Then we were thrown into a room that was ironically and appropriately named the Bunker Hill Room. You couldn’t have had a better room name, because the tension in that room among Democrats was incredible—Baucus was feeling guilty, Pryor was depressed, Stark was furious, Rockefeller was mad—and this was just the Democrats, OK? Kennedy, as I recollect, was sitting there with great disappointment because he knew that the latest best opportunity to move the healthcare reform agenda forward was crumbling before his very eyes. Stark started yelling at Baucus, “You are obscene. We threw all this money at you, and you still couldn’t vote for this?” Rockefeller retorted, “I asked you not to talk to the press.”

Pryor got up, because Stark made it so personal against Baucus, to defend Rockefeller, but particularly to defend Baucus, even though he was so mad at him. This was such an outburst for David Pryor; he never got mad. He was so upset he was almost shaking. Yet, even in the force of his dismay with Senator Baucus, he defended him against Stark’s attack. In his mind, it was another rule of the Senate. You don’t have a House guy personally attack a Senator. They almost literally got into a physical fight over this, and if you ask anyone who was in the room, they’ll tell you this. They’ll say, “Oh, my God, I thought they would maybe start punching each other.”

To get back to Senator Kennedy, I believe he viewed the Pepper Commission as a potential springboard into coverage, and then when it became real, he would engage. Until then, he would be the helpful, nondemanding member who has to be there because he’s Ted Kennedy. Behind closed doors, though, he had his staff successfully pushing for his priorities; in this case it was David Nexon, who was one of the most relentless and productive staffers ever. Some found David annoying, but he was effective, and he had the Senator’s back at all times. (His relentlessly optimistic chief of staff, Nick Littlefield, was the same way throughout the Health Security Act debate.) Kennedy hoped the Pepper Commission was a pit stop along the way to the ongoing debate on healthcare. But the truth was, because of that 8-7 vote, it didn’t springboard much into health reform discussion. If anything, it slowed it down. There was a lot of anticipation, and then not much happened afterward.

The fact that the commission was as stacked as it was, and that you would have expected a more positive outcome, do you think this revealed to Kennedy that the way ahead might be rocky, that there was more opposition than he expected?

I think he knew well before then how hard this issue is. He had seen the Medicare debate, the failed [Richard] Nixon universal coverage debate, the Carter years, and the Medicare Catastrophic Coverage Act repeal. He had regretful memories of the time when Nixon supported an employer-mandate plan and Kennedy insisted on a single-payer plan instead. He viewed it retrospectively as a historic lost opportunity. Even then I think he looked back to say, “If I had to do it all over again, I might have embraced that, passed it, and fixed it later.” You’d have to ask him, but that’s an interesting question, because a lot of people look back with great regret.

Longing for what if.

Longing or wondering. He looks back and questions whether it was a strategic error to not take advantage of a Republican President who was embracing something that was universal in nature. Although it wasn’t exactly what people wanted, it would have achieved the ultimate objective. Since that time, Senator Kennedy has been willing to pursue other courses. He had a constituency to take care of, obviously, but I think he has consistently illustrated that he’s still open to compromise.

The mythology of Ted Kennedy is that he is the left-wing advocate. He pushes his interests as much as he can, but as a consequence of his image, he gets a lot of leeway to cut deals with people that other Democrats could not. He is a legislative pragmatist. He is viewed as the most successful legislator in the history of the Senate because he cuts deals—deals that sometimes alienate his base, but the base allows him to do it, unlike anyone else. It’s primarily because of his image as a leftward liberal. “If he’s for this, it must be OK.” Senator Kennedy’s name boxes in a lot of Senators who believe they can’t tell their constituency that they would be to the left of him, even though frequently they are.

Another thing about Ted Kennedy, which I think is a tribute to him, is that I know of no Senator—and I’ve been around them all—who works harder than Ted Kennedy. There was never a meeting in the White House that he came to unprepared. I always lamented the days he would come up, because I knew he would have a list. I knew Bill Clinton would give me a list, and he would write on the note, “Why can’t we do this?” or, “Why aren’t we doing this?” Kennedy would hand it over to Bill Clinton, and Bill Clinton would hand it over to me. As much as I lamented it and sometimes even despised it, I was impressed by it, because most Senators get into the White House and they get awed by the place to the extent that they forget why they are there or the opportunity they have. But Kennedy viewed every meeting as an opportunity to advance his agenda. He would, believe me, be the socializer extraordinaire, and he’s one of the most fun Senators to be in a room with. People love to talk to him, and people want to do things for him. But the point is he does the work.

Not only does he bring the list, he then does the follow-up. His staff says, “You need to call this, and this person, and you need to write a note to this person.” It isn’t just a wish list; he does it. The reason why he’s successful isn’t just because of his personality or his blue-blood background or his history or anything like that. It’s because the man works, and I think that people don’t get that. People don’t understand that part of him. They think people help him because they want to cast favor with the Kennedys. That’s not wholly untrue, but the work is the biggest reason. Or they think that he’s a leftward-leaning person and he won’t cut deals. He is the most artful negotiator. If anything, a lot of Democrats think he goes too far to the right to cut deals because sometimes he’s so interested in piling up his legislative achievement list. There isn’t a majority leader who has served during Kennedy’s time in the Senate who has not been frustrated by Ted Kennedy, but they can’t do anything about him.

But Ted Kennedy never attends a meeting with a majority leader in which he does not call the leader “the leader,” and is completely deferential and supportive of him. He works it. He goes into those rooms, and he plays them up, and he says, “You’re the guy, and I’ll do anything for you.” And, by the way, if they’re in trouble personally or anything, he’ll do whatever it takes. He’ll write a note; he’ll call a doctor; he’ll do whatever; he will do personal favors for them. But when it comes to what he wants to get legislatively, don’t be in his way, because he’ll run you over. “I don’t care whether you’re a member of the House or the Senate, the majority leader, or the President, I’m going to get this thing done.” I think he’s one of the few people who can get away with doing that, and people still genuinely like the guy. Whether it’s Al Simpson—

Who loves him.

—who loves him. Frankly the people who get most frustrated with Ted Kennedy are the Democrats, not the Republicans. The Republicans respect him. They respect power and its successful application. You talk to any Republican and they’ll tell you, outside the beltway, they hate him and they revile him, but inside the beltway, they respect him. That’s what Washington is all about. It’s about power and respect, and that guy has both. Anyway, I’m sorry to digress.

No, we need all this.

The bottom line about the Pepper Commission is that I don’t believe he personally was substantially engaged, because it wasn’t real. When it becomes real, then he does engage, and if anything, he takes over. It wasn’t then time for him to take over. He let Jay [Rockefeller] get the limelight and eventually most of the blame for its lack of success.

Ted Kennedy has a sixth sense about when the time is right to strike on an issue. And he has an endless number of connections that go well beyond health policy history. The relationships, the political alliances, are in D.C. and throughout the country. The combination of his timing instincts and these relationships is formidable. What strikes me about him is that he seems to know everyone in the country who has any political influence. He’s been around so many people, and he does those extra things. Even people who you would think are pretty low-ranking in the overall scheme of political life, he remembers their birthdays, or he gets someone to remind him about birthdays, and he calls people up—not just people who are important in D.C., but people who are important back in Massachusetts. He doesn’t forget them. I see that all the time, and I never cease to be amazed at his energy.

There are people he doesn’t like, and I have been in rooms where he is cold as ice to them. But mostly he is a pragmatist. He is like, “I’ll do whatever it takes to get my agenda done. If I have to talk to someone I hate, I’ll do it, but only because I have to.” But he does not waste his time on an issue until the time is right. Every time there’s a connection, like in ’91, when Harris Wofford won Pennsylvania surprisingly and the healthcare issue catapulted him into that shocking win—I think it was over [Richard] Thornburgh.

Richard Thornburgh, yes.

The Woffords have a close connection to the Kennedys from his work with JFK. It seems like every time there’s an event in healthcare or whatever, the Senator has not only a policy connection, he has a personal political connection too. He could sense something was happening. Then he saw Clinton win in ’92, on the slogan, “It’s the economy, stupid, but don’t forget about healthcare.” Healthcare was the big issue, and he saw that as the next great-big opportunity. He was going to play from beginning to end throughout that process. He was the most involved member, from a White House perspective.

But without taking the credit for it.

It wasn’t because he wouldn’t want to take the credit for it. It was that he wanted to be on the inside, but if other people knew he was on the inside, then more people would be on the inside, and that would reduce his influence. That was a strategic move. Believe me, when there is credit is to be had, the Kennedys and their staff are first in line to claim it.

But there are many times when he doesn’t claim it, for strategic reasons.

Oh, yes. I’m saying that he claims it at the end of the process. He gets that that’s the most important time, not at the beginning.

Within the White House for health reform, we had a big health task force. We had the worst of all worlds. Everyone was involved, yet the perception was it was secret and secluded, even though hundreds of people were participating. Only we could have achieved having hundreds of people involved while having the outside world think that the task force was small, secluded, and secret. Yet somehow we managed to achieve both statuses. There was a lesson I learned in that process. Ira [Magaziner] advocated for the process of casting a wide net in order to get creative ideas in health reform. Some of the best thinking in healthcare was produced from that process.

But the makeup of the task force tended to alienate more than unify people. That was because, if you were going to have that large a group, hundreds of people, involved in the development of process it was going to be quite unmanageable. Yet, although large, it’s still a small segment of the policy and political world—and if you’re not one of them, you’re mad. You’re not interested in talking it up or saying positive things about either the process or the substance, because you were implicitly rejected from this group of people.

If it had been a traditional Washington insiders’ game, where you had three or four or five major players, people would say, “That’s the way Washington works, and I know him, or I know him, or I know how to get her,” or whatever, and you play the traditional process. People are much more accepting of a small process than they are of a big process, because the smaller it is, the less the people who are on the outside feel excluded.

Since this was Ira’s idea, did anybody challenge it? Did anybody not see the pitfalls that this was going to create?

Yes, a lot of people challenged it. The Departments who are traditionally in charge of these things would say, “What the hell is this process? Why is there a Department of Health and Human Services? Why is there a Department of the Treasury? Why is there a White House, an OMB [Office of Management and Budget]? Why do we need to have all these outsiders come in?” So there was an internal process concern, which was why, when they didn’t like the direction it was going, you’d have leaks primarily from the Departments, not from the task force. Even though they were part of the task force, we had that problem all the time.

Then, of course, the committees of jurisdiction would say, “Why are you inviting all these little staffers or members of whatever, who aren’t the chairmen of the committees of jurisdiction? We’re the ones who do business in this town. Who are they to be playing in that world?” They were pissed off about it. They weren’t treated as special. They weren’t treated like the unique power centers that they are. So they didn’t like that either, and they weren’t quiet about that. There were problems in that regard throughout the process.

Did Kennedy critique it? No. Kennedy just found another way to get on the inside. He said, “There has to be another place to have meetings.” Sure enough, he supported everything they did, and he got himself inserted and his staff inserted into some ongoing, more insular, quiet, individualized meetings with Ira and Hillary [Clinton] and other people. He bypassed the process. He was supportive of it from the outside, but that’s because he knew from the inside that he was covered too. That shows me his thinking is, I think it’s a stupid idea, but I’ll deal with it by taking care of it myself, and I’ll be supportive from the outside. It’s the best of all worlds. I’m the loyal soldier doing my job, but I’m also influencing and controlling the agenda from the inside, but no one knows about it. That’s the best of all worlds. That’s Ted Kennedy at his unique best.

The reason he was in was not just because of his stature and his status and his unyielding pressure to be the player, but because he could deliver a staffer or staff support that was value added. If they said they were going to produce something and work something, they would do it. They wouldn’t complain. They’d be quiet. They would push and push, but they would be productive. He also understands the value of good staff. He gets the whole picture. That’s the thing about Kennedy. He knows that he’s not going to be the drafter of the legislation, and he knows he’s not going to be the person who will know every provision of every policy, but he knows what he has to know. He knows what he’s good at, and he knows that good staff members supplement what he’s good at. That’s why he has people who will die for him, people who will work with him for years and who are always around him, because they see him creating miracles. You see it all the time.

When he was in the minority party in the Senate, why would anyone deal with Ted Kennedy? Because through his force of personality and his strategic sense and his staffing capabilities, he gets people to work with him. Also because people know that if they pick up Kennedy then they’ve picked up at least a third of the caucus. No one wants to be to the left of Kennedy. He’s not stupid. He gets all that, and so do the Republicans. They know also, if he makes a deal, he makes a deal. He honors the deal. That’s why he is as good as he is.

So that’s what he did in the development of Health Security Act. He was happy with how it was structured and with how it would be drafted to be referred to his committee so that he could share jurisdiction with the Finance Committee. That was part of the game too. He didn’t want this to be a Finance Committee-only thing. He wanted to be a big player, and that was how he would do it. That was a big reason why he wanted to get involved on the inside.

He got involved in the debate by trying to make certain that the Director of the Congressional Budget Office, Bob Reischauer, didn’t blow up the bill by calling the employer mandate an on- budget tax, which he ended up doing anyway. He spent a lot of time, he and his staff, working that issue, because he was sure that the Republicans would try to make that a substitute emblem for a government-takeover label. He tried to work that with Bob Reischauer, and he was convinced that that would end up killing the Health Security Act. That ended up not being the reason. There were many other reasons why the Health Security Act did not succeed.

Ironically, with all the failures and shortcomings of the process—the unveiling of the Health Security Act and Hillary’s subsequent testimony around it on Capitol Hill, five separate committee hearings, including Kennedy’s—at that time, the Labor and Human Resources Committee was a successful rollout, all things considered. It got a favorable review. Hillary testified brilliantly. It was off and running, but it was standing on quicksand. The timing was hard. There were so many other political issues going on.

Talk about the timing.

The untold story of the Health Security Act, I think—everyone wants to talk about the detailed plan or Hillary or Ira or the task force and all those things that contributed negatively. But I think the fundamental issue was that there were so many other policy distractions and so- called scandals that negatively tainted the environment, both from the public’s perception and the Congress’s perception, that it would have been very hard to pass the Health Security Act even if it were the Bible. The truth is, the President had spent a lot of political capital on deficit reduction. Senator [Robert] Byrd had rejected the idea of healthcare being incorporated into the budget reconciliation process, which is what [George] Mitchell wanted.

Did Kennedy want it on reconciliation too?

Oh, yes. Anyone who wanted a healthcare act wanted it on reconciliation.

Didn’t they know that Byrd would never let it go on there?

They didn’t know.

Did they think they would get Byrd?

They had hoped that they could get Byrd to go along, and they worked it. But Moynihan and Byrd were adamantly opposed—Moynihan, just because he hated the Clintons; Byrd, because it was an institutional thing. He thought something that important and that big shouldn’t ride a budget reconciliation process. There’s obviously a valid argument to his case. But in the Senate, when you didn’t have sixty-some Democrats, and Republicans were likely to oppose you, Mitchell was going to try.

The moment that strategy was rejected was perhaps the death of the Health Security Act in retrospect. A lot of political capital had to be expended in both the House and the Senate to pass the budget bill. As you recall, it passed by one vote in each chamber, and as you know, since you were in the Senate, it’s hard to ask members of Congress to make hard votes more than once in any Congress. Beyond that, we were asking them to pass legislation on crime, which is not easy, taking on the NRA [National Rifle Association], and on NAFTA [North American Free Trade Agreement], on trade bills that Labor hated us for.

We had a situation where the right was mad that they had to do the deficit reduction and crime. The left was mad that they were voting for or against NAFTA, and they were saying, “Wait, deficit reduction and trade? I thought we had a Democratic President.” Healthcare was supposed to be the issue that the left wing of the party wasn’t going to compromise much on. This was something they really wanted. We had Senator Bentsen, who left the Finance Committee and who was the strongest chairman we’ve had in years, to be replaced by one of the weakest chairman ever in the history of the Finance Committee, Senator Moynihan. We had Dan Rostenkowski under investigation. So you had the two people who most likely could have pushed it through: one compromised, the other left, replaced by Senator Moynihan, who didn’t think healthcare should be the priority. He thought it should be welfare reform.

So, what people forget about healthcare is that it was dropped into an environment where many other difficult political capital expenditures were being spent on other policies. On top of all those issues, you then had Whitewater, Haiti, et cetera.

How about gays in the military?

Gays in the military, the issues that people remember that tended to weigh down the President’s popularity and trust. Remember, he didn’t exactly get 70 percent of the vote. Republicans didn’t think we had a mandate to do much, and they weren’t going to help us much. All those things were weighing down the public’s support of the President. Because we chose to do deficit reduction and then NAFTA and other heavy lifts first, healthcare had to wait until 1994. Each day that passed that healthcare was out there was a day in which we were becoming more and more unpopular and weaker.

The Republicans smelled blood. People who would have otherwise been supportive of doing healthcare, including even Senator [Robert] Dole, were starting to be pressured by the right to say, “What are you doing?” Remember [William] Kristol and that famous memo that said, “The only thing you can do to lose our chances to reclaim the Congress is to give Clinton the healthcare bill”? That was circulated everywhere, and most Republicans viewed it as gospel. It became clear that even if we brought up the Republicans’ bill on healthcare, they would have run away from it. Indeed, Senator Dole once remarked how he hoped we wouldn’t bring up his bill because he would have to vote against it. They simply didn’t want to have any healthcare Rose Garden signing ceremony.

Remember, this happens when the Democrats, particularly conservative Democrats who were in vulnerable Congressional districts, were saying, “You made me vote on all these difficult issues, and now you want me to vote on an employer mandate, and you want me to vote on an issue that the insurers are going to use against me in advertisements. You’re crazy. You can’t make me walk the plank.” That was the political context.

I would suggest that it was all these other things weighing down, yes, a difficult and excessively detailed plan, but the plan, in and of itself, was not the reason why healthcare didn’t get passed. There were other reasons that contributed as much, if not more, to the political receptivity for it. I think people miss that.

The transition team, headed by Judy Feder, had been working on an employer- mandate plan. Then Ira Magaziner made the decision that there would be a big task force. If a plan had been presented that January, do you think there would have been enough political momentum? If Clinton had walked in and said, “Here’s the plan—”

“Let’s move it.”

“Let’s move it.”

That is a hypothetical question, and we’ll never know the answer. I think there would have been a better chance, only because you had the honeymoon period. You have a chance, if this was to be your priority, you might have been able to get it through. Let’s put it this way: It would have had far fewer barriers than what I’ve laid out, because we wouldn’t have gone to the task force; we wouldn’t have had all the departmental problems; we wouldn’t have had the Congressional problems; we wouldn’t have had to carry the weight of all those other votes beforehand, where people said, “You made me vote too many times on tough issues.” There are many other reasons why that would have made it easier. Would it have made it likely or possible? I think healthcare is tough. I don’t know. I think it probably would have been more likely.

The issue is the lesson for the future. What can be taken from it?

I think the lesson for the future is if you want to do something as big as healthcare, you should consider doing it when you’re at your strongest politically and when you’re willing to spend political capital and time for it. That may be during your first term, your first 100 days, and it may be during your second term, your first 100 days. It depends on the environment. You may be at war, you may have huge deficits, you may have a tax issue that you have to deal with first—all these other things. You may have a Social Security crisis. You don’t know what faces you.

I wouldn’t say it has to be the first term of every President, but I think it has to be when you’re strongest politically, and we didn’t do it when we were strongest politically. The President was probably strongest politically right after the 1997 Budget Act. That was probably when he was at the apex of his power, but he didn’t have a Congress to help him. The Congress had already been flipped. So you also have to have a friendly Congress or a receptive Congress, and obviously they hated him. It is a political timing act. Is the country ready for it? Is the Congress ready for it? Do you have the political capital to expend? Do you have strong chairmen who will deliver for you? Because in the end, Congress has to be invested.

I think the other lesson of the Health Security Act was we had a detailed plan that no one was invested in, particularly after they felt it wasn’t popular, so they ran away from it. The lessons of most tough, successful health reforms have been that the President or the Governor who proposes it doesn’t throw out tons of the details or does not invest in one particular approach. If you look at Bush’s prescription drug benefit, which probably cost close to a trillion dollars over ten years, he never, in the campaign or in any year he was President, submitted any legislation on the Medicare drug benefit. He just signed one into law.

That’s right.

If you look at [Mitt] Romney and his universal—

The Massachusetts plan, yes.

He passed legislation. Actually he vetoed it, and then it came into law, but he gets credit for it. Many of the details were left to a commission entity to develop the subsidy stream and the benefit package that would be the governing policies. A lot of the details were left to later and the legislation included a broader investment of people than one person. So the lesson is that it has to be our plan, not my plan, and there have to be other people who are involved and invested, including, obviously, the Congress. When it becomes, “I’m trying to pass your plan, Mr. President,” then it’s a lot harder than, “I’m passing our plan.” Every President knows that if he signs something into law, he’ll get their share of credit. He doesn’t need to have the bill at the front end.

The irony is that a lot of the people on the Hill wanted the language, including, by the way, Senator Kennedy. He wanted the language because he wanted the referrals to his committee, and the committees of jurisdiction wanted the language because they wanted to expedite Congressional Budget Office scoring of the policy, because they thought they needed to get a fairly quick score in order to move the policy relatively rapidly. Many deny that now, by the way, but I was in meeting after meeting, and they wanted to have the legislative language up there.

In retrospect, everyone now says a detailed plan was not helpful. That didn’t facilitate a positive reception to it. It just gave excuses for people who opposed it to spend time taking pieces out of the bill, criticizing it, not because they cared much about the provisions, but because they wanted to slow the bill’s progress.

Once it came to the Hill and there were the jurisdiction problems between Finance and Labor, all the committees started drafting their own bills. What did Kennedy’s bill look like when it came out of the Labor Committee?

It was similar, but he wrote it into the Public Health Service Act so that he could get the referral. Some of the language in the original bill that we submitted already had been drafted largely like that. But the truth is, the jurisdictional issues and squabbles always contribute to the legislative challenge of healthcare reform. It is a problem. It is something that, over the years, you’ve seen whole conferences held up while waiting for the Ways and Means Committee, the Energy and Commerce Committee, to fight out what policy they would jointly support when they have joint jurisdiction. Having said that, that’s what they do. It always has to be worked out. It slows down the process.

Kennedy tries to get his share of the jurisdiction from the Finance Committee and vice versa, and there will always be tensions there for the most part, since the HELP [Health, Education, Labor and Pensions] Committee has more than its fair share of healthcare issues. He would love to have Medicare or Medicaid, but Finance isn’t going to give him that. He would like to have tax authority, but he’s not going to get that either. He certainly still exerts his role and his influence.

A lot of people argue that we wouldn’t have had a Medicare drug benefit without Ted Kennedy, even though he voted against it. He created the momentum for it on the Senate side. Similarly, people say that we would not have a children’s healthcare program without Ted Kennedy. And that is probably true. But these bills didn’t get drafted through the HELP Committee. People don’t know that that is Finance Committee jurisdiction. The health financing and coverage issues of our day are not HELP Committee primary jurisdiction, and yet he always finds a way to insert himself at all times on all these issues.

Once the action shifts to Congress, what was his role once it was there, and what was his relationship with Mitchell on it?

Although Mitchell and Kennedy always had their tensions—and you might want to talk to Mitchell and also Chris Williams, who is the former leader’s staffer and is now at the Agency for Healthcare Policy and Research right now—I would say that for the most part, Mitchell viewed Kennedy as the least of his problems. Mitchell had a problematic Finance Committee. He had a hostile chairman, and he had many members who were opposed to voting for any type of employer role for healthcare. He viewed Kennedy largely as a supporter who would do anything he could possibly do to create an environment for a success.

I remember that Mitchell specifically hung around the Senate for healthcare. He wanted to finally get real reform done; [Thomas] Daschle, who was one of his lieutenants, was in the same boat as was Jay Rockefeller. There were other members in the Democratic Caucus for whom it wasn’t their number one priority, and Moynihan certainly was one of them. Moynihan made clear that it was not going to be the administration’s bill; it was going to be his bill.

Where was Dole on this?

Dole was interesting. If it were up to him, I think he would have loved to have been a contributor to the Comprehensive Health Care Reform bill. I still believe that. He has something in him that he sees this as a hole in the American fabric. He’s an honorable guy, I think, for the most part, but he’s also a political pragmatist. If you asked him in ’93 and early ’94, maybe he could have worked with us, but it would have been, in his mind, political malpractice to give a political victory to the President on healthcare when he was dying on the vine before him. It was his chance to take over the majority leader position. It was his chance to take over the Congress and his chance to lay the predicate for a next President. He wanted to be President.

He wanted to run.

He wanted to run. But if the cards had been right early on in the first year of a Presidency, I think Dole probably, all things being equal, would have wanted to be helpful. You haven’t talked to Sheila [Burke] yet?

I haven’t talked to Sheila yet.

I bet you she’ll tell you about it too.

What was your sense about where Sheila was?

Sheila always reflects her boss, but I think she would be like that too. She wouldn’t have embraced the Health Security Act as it was drafted. I think they would have been more oriented toward the [John] Chafee bill. Chafee was very much involved in working with Dole and [John] Danforth and Durenberger and [John] Kerry and the so-called mainstream or centrist or whatever they call themselves.

Mainstreamer.

They were originally for an individual mandate, which would have been a universal coverage initiative. They moved off of that eventually, but that, in retrospect, might not have been a bad place for us to be, in the ebb and flow of the policy and the political. It wouldn’t have been popular with the public, but we might have been able to get something signed into law. People who say, “You should have cut a deal,” do it outside the filter of what was also happening, which I’ve laid out—the budget and the crime and trade bills.

If Clinton, after all those tough votes, had said, “Let’s do the Republican healthcare reform bill,” they would have hung him. “Why are you making me vote for crime and trade and deficit reduction? You’re looking like a Republican.” The House Democratic base was not going to an individual requirement—nor would have most House Republicans. It may have been a smart geopolitical strategy, but we didn’t start doing meaningful triangulation until after ’94, where I think the President got his voice and tried to show Democrats how we could work to get some things done. In that phase of the game, that caused tensions with the Democrats too, once he started cutting those deals.

A great example was when we created a bipartisan agreement on healthcare in ’96, with Kennedy’s strong support—the Kennedy-[Nancy] Kassebaum, the HIPAA [Health Insurance Portability & Accountability Act] legislation. Kennedy was critical to getting that done—just as Bill Clinton was. Having said, a lot of Democrats didn’t want a deal. They thought, Why are you giving victories to the Republican Congress so close to the 1996 election when we can win and take over the House? There was a lot of hostility about that. But Kennedy sided with the President, or the President sided with Kennedy. I can’t remember who was first. Regardless, they both thought that when we have the opportunity to do something, we should opt for progress over stagnation.

Where did the idea originate?

Insurance reforms?

Yes.

Insurance reforms had been around for a long time, back in the late ’80s, early ’90s, to address some issues. Ironically, in ’91, ’92, a lesser version of those insurance reforms had been talked about, and the Senate Finance Committee—particularly Lloyd Bentsen—wanted to proceed with it. But the dynamic going into the ’92 election was such that everyone was so excited about universal coverage that they thought that if you pass insurance reforms, it would stop or delay any movement for broader health reform. A lot of Democrats argued against doing a fairly modest set of insurance reforms in ’91, ’92.

Then you go through the Health Security Act, ’93, ’94, and ’95, and nothing happens. We had a pent-up demand for changes in healthcare. We felt we had to get something done. We went through the closing of the government and the public was saying, “Can you guys get together on something?” And there was a lot of pent-up demand on policy; legislators were saying, “I’m tired of throwing things. Let’s get something done.” On top of that, the President endlessly and relentlessly at Senator Kennedy’s urging—publicly held the Republicans’ feet to the fire. Kennedy was more than ready to cut a deal. You could just sense the issue and the achievement was in our grasp.

It’s funny, you recount it and it all becomes quite clear how it came to be, but it came to be largely because Kennedy and Clinton collaborated. Clinton was calling him almost on a weekly basis and asking, “Why is this being held up? Why aren’t we passing this bill? Why aren’t we moving forward?” “Challenge the Congress to move it.” Kennedy was saying, “Use your platform, use your megaphone. You’re helping me up here.” Then Kennedy would use that to push the Republicans to cut a deal and to hold the Democrats who wanted more at bay, by saying, “Look, we’ll never get more than this. I’m going to have to reject amendments that I otherwise would support.” That’s what Kennedy and Kassebaum both had to do. They had to oppose amendments that they otherwise would have supported on the floor.

They got to conference, and then we had to deal in conference with the [Newt] Gingrich staff and other people on the House side. I was involved in the negotiations of that throughout the process, with Ken Kies (of the Joint Tax Committee) and David Nexon and myself and John Hilley (the head of our White House Legislative Affairs shop). I remember that we had a meeting with [Dennis] Hastert. It was interesting. We spent lots of time on it. The bottom line is, there were a lot of people in the Democratic Party who said, “Why are we doing this politically?” They ended up voting for it, but boy were they mad.

You raised an interesting point that I had forgotten about—the issue of the government closure that Christmas. Did you get a sense at the time that it was galvanizing both Congress and the President to do something that showed they could work together, because public pressure said, “What are you guys doing here?”

Yes, and they both needed it. The Congress needed it. They were very unpopular. Gingrich, do you remember the plane ride thing and the crybaby thing and all that stuff? They were looking pathetic, and that’s why the Democrats were saying, “Don’t give them anything. What are you doing?”

The President was probably coming into his strongest point. He had taken on the Congress and won. He learned that he could veto and become stronger. He took a position and was happy with himself. His staff and his administration couldn’t have been more proud with him. There were a lot of people who questioned whether Bill Clinton would stand up, and he did, and he did forcefully, and they found that he did have the backbone that they hoped he had. He drew a line, and people loved it, and it strengthened him more than anything.

But he learned through that process that he couldn’t fight something with nothing. He had to have an alternative vision. The reason why he insisted—against the recommendations from the Hill—of having his own balanced budget was that he wanted to have something to compare and contrast with the Republicans. He said, “You can balance the budget in X years, but you can do that while maintaining our fundamental principles and priorities in these areas of health, education, and environment.” He showed how you could do it. Then that bolstered him. He said, “I now have a position,” and that made him stronger in the budget negotiation, and that led to him being able to say, “There’s an alternative course, and they’re not going to take it. I’m going to veto this legislation.” He felt strong.

The big healthcare debate about that was Medicare and Medicaid. The focal point of that debate, the irony of the budget debate, was that it was health reform in reverse. It was dismantling Medicare and Medicaid. They had $270 billion in Medicare cuts. They had $188 billion in Medicaid cuts. They were block-granting the Medicaid program. People were desperately worried that we were seeing the ripping up of the fundamental social contract in healthcare that we had built up over the years, the one that made the difference between people living or dying in this country. This was serious stuff.

If you ask anyone, like Gene Sperling or anyone else, about when Clinton vetoed that bill, “What was the big issue?” he and I will tell you that it was the Medicaid block grant. It was when they were going to take away the guarantee of healthcare to poor people and the guarantee of financing to states to pay for that population. He said, “I will not stand for that. I will not be the person who signs that into law or allows that to become law.” It was a defining moment. It strengthened him, and it made him feel stronger and better about himself and his standing, both within the government and with the public.

He started pushing insurance reform, because the Republicans were perceived to be bleeding. In fact, after the demise of the Health Security Act, he wrote a letter to Gingrich and Dole in ’94, right at the very end of that awful process, and he said, “I want to do insurance reforms, I want to do deficit reduction, I want to do children’s health coverage.” He laid this out in December of ’94. Those were my marching orders for the rest of my career in the White House. In fact, I still have it on my wall over here. This is my reminder that sometimes you write something that has some relevance. Anyway, that’s what we did. Those were my marching orders, and we were going to do that. Frankly there were some important policies that were included in that legislation—not just the insurance reform but the underpinnings of the privacy protections and genetic discrimination. That year was a big year.

This was ’97?

Ninety-six. That’s why the Democrats’ leadership asked, in the House and Senate in particular, “Why do you keep having these Rose Garden ceremonies? You’re making them more popular. You’re letting them win.” He and the public and the Congress and Ted Kennedy wanted to see something get done, and ’96 and ’97 became the two biggest years for health reform of substance. In ’97, of course, we did CHIP [Children’s Health Insurance Program]; also SCHIP [State Children’s Health Insurance Program], and we had Medicare reforms and a host of other things as well.

These ideas, which had long been part of Kennedy’s agenda but not at the top of his agenda, got momentum when Clinton laid out, at the conclusion of the healthcare reform debate, that these were his top agenda items in healthcare.

I would say that it was more complicated and convoluted. What happened was, ’95 was the pendulum swing. From the Republicans’ perspective, universal coverage was going to be nothing less than a government takeover of healthcare (inaccurate as that was). They were intent in stopping it and any perception of success in this area. Then the Republicans took over, and with all their new power and momentum, they said, “This is the opportunity to go after Medicare and Medicaid,” and they went after it with gusto. Just as they would argue that we went too far too fast on the comprehensive reform provision, we would argue that they went too far too fast on their dismantling the social-health-care infrastructure of Medicare and Medicaid. This country, with its safety brakes, stopped both of these efforts.

As would the attempt by [Ronald] Reagan to dismantle the social network in the early ’80s too.

Right, exactly.

The country said no.

You can go so far, but at some point, the public’s openness to change stops. Once the Republicans reached that point in the beginning of 1996, they understood they were way out there and hurting. The President saw an opportunity, and Kennedy saw an opportunity—they’re both political beings—and they said, “They want something. They need something. I want something. I care about getting policy done.”

Fundamentally, Bill Clinton never wanted the Presidency just to hold the office or to get money. He wanted the Presidency to use the power to get something done, and he was frustrated after ’93, ’94, and ’95 (although we’d had some major achievements in ’93 and ’94—and won a big fight ’95). He wanted to see substance getting done because he cared about getting policy. He wanted to show that we were making progress. Obviously he was also up for reelection in ’96 too, and the Republicans were in the danger of losing seats. He thought there were plenty of other issues that Democrats and Republicans could fight over, and they were clear. However, if we could get some of these health reforms achieved, he thought we should take advantage of that.

So, building on that 1994 post–Health Security Act letter, we and Senator Kennedy saw a great opportunity to pass bipartisan health reform with the introduction—and broad bipartisan support—of the Kennedy-Kassebaum health insurance reform bill. At Senator Kennedy’s urging, President Clinton used the power of the bully pulpit to pressure the Senate Republican leadership to bring the bill up for a vote (after it had been successfully passed out of the Senate Labor and Human Resources Committee). To get Senator Kassebaum to cooperate, Senator Kennedy had to agree to oppose amendments on the floor that he otherwise would have supported. A lot of Democratic leaders, particularly in the House, said, “This will not be helpful politically.” They had a different agenda at that point. They wanted to be the majority again and they thought that this “incremental” reform was not worth the risk of losing out on this opportunity.

The President wanted to get policy done, and his political strategists said, “You have to get some accomplishments too. You’re the President, and you’re up for election too.” In ’95 the Democrats’ leadership and the President were as unified as they had ever been, because they were fighting Newt Gingrich and his vision of the healthcare “reforms” and tax cuts that we all felt would fatally undermine the social safety net as well as harm the economy. In ’96 you saw a division where some Democrats said, “Don’t do anything because it is politically not in our interest to do that.” The President and Senator Kennedy countered, “We want to do something because we’re hired to get a get a job done, and we want to move ahead and, again, there will be plenty of election issues we can fight over.”

The Republicans, who were hurting—they were bleeding post-’95—concluded, “We need to get something done, and yes, we’ll have to give things that we otherwise might not have given to Clinton, but we’re going to do that.” That carried over, post-’96 into ’97, with the Balanced Budget Act, where there was a window of opportunity to get the balanced budget done. The economy was improving, and you could do something meaningful in a lot of the social welfare areas like refundable tax credits for low-income workers and of course SCHIP. That was another big thing that Kennedy was involved in too. He created a dynamic. He wasn’t the ultimate player on the committees of jurisdiction who drafted that bill, but he certainly—

That was Finance, wasn’t it?

Yes, it went through the Finance Committee. If you ask anyone on Senator Kennedy’s staff, they’ll call it the Kennedy bill. It drives the Finance Committee members crazy that he claims credit for SCHIP. If you talk with Ellen Doneski of Jay Rockefeller’s office, that drives them absolutely nuts. Or talk to Chafee’s people or talk to [John] Dingell’s people—they say, “What the hell are you talking about?” Ironically, the first person in the Senate who I recall doing a children’s healthcare bill was John Kerry of Massachusetts, but no one remembers that. Kennedy, because he set the stage for it and did the behind-the-scenes political and policy work, and because he’s bigger than life, has received most of the credit. Most of it is completely justifiable, but important contributions were made by the Finance and Energy and Commerce Committees, as well as the principals and staff of the Clinton administration throughout the legislative process (and on through SCHIP’s implementation).

Kennedy did push hard for us to put children’s healthcare in our budget in that year. He advocated privately and publicly for us and the Congressional leadership to totally embrace the notion. He found allies in the administration to push the issue and one of the most effective was Hillary Clinton. Working with Kennedy, she successfully pushed for the policy to be in the budget, the State of the Union Address and, later in the budget negotiation. Senator Kennedy and Hillary were the biggest advocates for the budget for the program to be increased from $16 to $24 billion.

He was always the guy, the mouthpiece for the Democratic Party. He gives speeches every year at the National Press Club. He sets the stage for the Democratic agenda. He is always talking about healthcare, that his big healthcare issue was kids was totally relevant. He was the outside and inside driver but not necessarily the legislator.

Not the drafter.

Yes. He contributed. I’m not saying he didn’t, but it didn’t go through his committee.

If you look back at another missed opportunity for national health insurance, it was under the [Jimmy] Carter administration, where the big fight that they had between Carter and Kennedy, besides the primary stuff, was over whether you would implement it in stages and do elderly first, then kids, then this, et cetera. Kennedy said no because he was still wedded to—

The one big thing.

—universal single-payer.

Right.

It was unclear that Carter was as fully committed to actually doing it then.

Right. As Senator Kennedy gets older, I think he becomes more pragmatic. The labor community also contributed to that. The labor community used to oppose universal health coverage in the ’50s and before, because they viewed it as something they could deliver to their members, and they didn’t want to have competition from the government.

It was one of their chief bargaining tools.

Yes. Then in the ’70s, they said, “It’s single-payer or bust.” Well, they got bust. Now they’re complaining that every contract is about healthcare and they’re not getting wages, so they want to have healthcare. Now they’re more open to most anything, but people could say, historically, that the opponents of real healthcare reform were aided and abetted as much by the alleged supporters of universal coverage as they were by the opponents. I certainly felt that way. In ’93, ’94, the single-payer advocates largely took a walk on a President who was supporting a policy to cover all Americans; like many other opponents, their second option appeared to be nothing.

Some of the single-payer advocates, and they’re maybe a third of the Democratic Party, maybe 20 percent of the country or something like that, believe their vision is the only way to go. And everyone who doesn’t support their vision is in the pocket of the insurance industry. The only problem with that is, (at least then and now) their position doesn’t get close to the, at minimum, 51 percent support we need in the Congress. That was the problem with the Health Security Act, even within the Democratic Party. You had the single-payer advocates. You had people who said, “I’ll support Clinton no matter what it is because I care about the reform,” and there were people who said, “I don’t want to do a mandate.” That was just the Democratic Party.

We had a third, a third, a third. You can imagine, if you only have a third of your party with you, and the other two-thirds are fighting you, and the labor movement is pissed off because you’ve done a trade bill and deficit reduction—you get a sense of why the political dynamic, beyond everything else I’ve described, was very tough, because the supporters were, at best, not hardcore supporters. The opponents were hardcore opponents, and they went all out to oppose the bill.

Again, one of the lessons of health reform among the advocates has to be, when you have those rare opportunities to get something done, and it covers every American, just support it; you can always fix its shortcomings later and it will be easier to do so because everyone will be in the system.

Democrats don’t do that.

Too rarely they do, although increasingly Senator Kennedy is (though again some say he can go the opposite extreme). As long as I’m alive, I’ll tell everyone that I will support any President of the United States who proposes a policy of quality, affordable coverage for all Americans. I don’t care what it is; I’ll support it. I will write op-eds. I’ll get political support. I’ll encourage stakeholders to support it.

How important were the Harry and Louise ads?

They were notable, but weren’t the reason for the demise of the HSA [Health Security Act]. They were important for three reasons: One, they scared people, and fear beats hope in Washington. Two, our and the media reaction to them got them far more attention. The irony of the Harry and Louise ads was that their ad buys didn’t get them anywhere near as much airplay as the media’s free playing of them did. That was driven largely by our complaining so much about them. Third, we didn’t have an effective response. As I said, our left wasn’t willing to put a lot of dollars into advertising. They weren’t particularly happy with this and with the trade policies and everything else. They weren’t as invested in defending or advocating for the Health Security Act.

My view is that the media tends to cover health reform through the filter of the plan and the personality of the person proposing it—and not contrasted to the alternative of doing nothing or next to nothing. Nothing means that costs will continue to go up, there will be more uninsured, there will be more cost shifting, there will be more waste, there will be more of all sorts of problems in healthcare.

I think that the next person who takes on health reform has to effectively make the point that the second option or doing nothing is no longer acceptable. We have to be far more effective at making people understand that they should be afraid of current law, of the current world, because, PS, they are. They are afraid of losing what they have, they’re afraid of costs, they’re afraid of not being able to be competitive, they’re afraid of their children graduating from college and not having healthcare. They’re afraid. We have to say that doing nothing means that that doesn’t get fixed. But we never do that. We say, “My plan is better than their plan.” Forget it. Next time we’ll do better. We’ll have learned a lot from these mistakes.

The reason why it’s interesting that Hillary Clinton is running is that in Washington, people say, “Don’t talk about healthcare, because that’s what ruined you.” But in the country, you go out and they say, “Wait a second. You’ve gone through this. You’ve learned a lot, right? You’re a smart person, and you’ll apply those lessons, right?” She says, “Yes and yes, and I did, and it was painful, but now what I’ve learned is that’s what America’s all about.” They say, “You get kicked down, you come back up, and you learn from those mistakes. That’s what it’s about. You’re more knowledgeable about this than anyone. Now do something about it.”

They’re not scared of her. They’re scared of people they’ve never heard of doing the tinkering. They know she’s becoming institutionalized. She knows the players, she knows how the deal works in Washington. In a weird way, she may be the best person to navigate this thing through. An inexperienced someone else may not be. [John] Edwards, who has turned to the left, well, that’s a great populism strategy, but if you don’t deal with these stakeholders in Washington, they’ll kill you.

With the Clintons, they say, “I’m not sure I like her. I don’t love her, but I know her.” You know how Washington is. It’s who they know. It’s like, “Do I have an in with them? Is there a way in? Can I figure out a way to contribute? Is there a way I can influence?” Right now the irony of Hillary is that she’s turned from the outsider to the insider, with both the good and the bad that’s associated with that. She gets praised by Michael Moore for trying but criticized by him for being part of the problem now.

My feeling is that the only person who can fix this from Washington is probably going to be an insider, not an outsider, because the outsider is going to get crushed. That’s what Washington does to people. Ask Ira Magaziner. He’s a smart, successful, thoughtful guy. They didn’t know who he was, and they killed him, and they loved doing it, because they didn’t know him, and there were no personal relationships, and there was no reason not to. That’s how Washington works.

Yes.

If you don’t get that, then you don’t get Washington. That’s how it works. They would much prefer Bob Dole and George Mitchell coming back and doing healthcare reform than they would some outsider they never heard of.

Right.

Whether or not they have financial interest or not. No one really cares in Washington. Don’t you think? That’s the way it works.

It is.

If you want to change it, fine. Do all the campaign reform you want. I’m for it. I’m doing legislation right now where I’m trying to get more affordable drugs to people, and these guys, the pharmaceutical industry, are the most influential group I’ve ever seen. They control everything, and they throw money everywhere. They’re successful, and you rarely beat them, and I hit my head against the wall all the time. I can complain about it, but it is what it is. I just keep working at broadening the coalitions to think about alternative visions.

In Massachusetts, I’m working on his legislation on biotechnology and trying to end the monopoly that biotech products have and I’m trying to give more affordable options for seniors and consumers. Kennedy’s an insider in that world because the biotech world is in Massachusetts. He’s not exactly Mr. Whatever-the-consumer-and-labor-and-business- community-wants, by any means. But you could say that he’s reflecting some of his important constituents. He is an insider. He’s not an outsider, but he’s gotten a lot of things done. And he’s not done.

That’s for sure.

One last memory I would like to share for posterity. On literally one of the final days of the administration, we decided to have a healthcare achievements celebration reception in the historic Indian Treaty Room in the Old Executive Office Building. We didn’t know which VIPs would attend, but I had the honor of emceeing the event. At the last moment, we got the word that the Dean of the Congress, John Dingell, Senator Kennedy (our chief legislative partner), Hillary Clinton, and the President would come.

There were recitations of our achievements, discs of the human genome awarded to the President by Francis Collins, and great remarks by Chairman Dingell, Donna Shalala, and the First Lady. But the most memorable moment was Senator Kennedy bestowing an original, signed copy of Profiles in Courage to the President. As he presented the book and shared his recollections, Senator Kennedy did something I had never seen him do—he teared up and broke down. It was a poignant moment I will never forget and well illustrated the bond the two had formed. I know that moment and that gesture meant the world to the President (and to those of us fortunate enough to be in the room.)

OK. Is that a good place to stop?

This has been terrific.