The Lion and his long game

I’ve been enjoying Nick Littlefield and David Nexon’s excellent book The Lion of the Senate, which chronicles Sen. Ted Kennedy’s remarkable legislative success during the 1990s in spite of Newt Gingrich’s 1994 Republican revolution. It provides a number of lessons for liberals today chasing a policy vision in Kennedy’s absence.

Kennedy’s top legislative aspiration had long been universal healthcare. He first articulated his vision of comprehensive health reform in 1971, proposing a single-payer plan that would have insured all Americans, and covered at least 70 percent of all medical expenses.

With comprehensive reform out of reach, Kennedy turned to incremental piece-meal reforms. In 1986, he helped pass EMTALA, which prohibits hospitals from refusing emergency room patients because they lack insurance. That same year, he helped pass an omnibus budget bill that extended health insurance coverage to the unemployed (commonly known as “COBRA” coverage).

Comprehensive health reform seemed within the country’s grasp early on in the Clinton administration in 1993. But that effort ultimately went down in defeat and sparked the Republican takeover of Congress. Rather than give up, Kennedy looked to build a coalition around smaller consensus, no-brainer health initiatives.

To that end, he teamed up with conservative Sen. Orrin Hatch to pass the Children’s Health Insurance Program in 1997, which provides health coverage for more than six million low-income children. This achievement, Littlefield and Nexon write, marked “a giant step toward universal health insurance coverage for children and a milestone in Kennedy’s quest for the day when health care would be a right, not a privilege, for every American.”

And of course, in his final years, Kennedy was instrumental in constructing the legislative framework that ultimately became the Affordable Care Act, the most comprehensive effort at universal healthcare in the United States to date.

Kennedy spent his whole career calling for reform that would transform healthcare from a privilege to a right. By 2013, President Obama was trumpeting the Affordable Care Act as achieving just that, declaring, “In the United States, health care is not a privilege for the fortunate few, it is a right.”

Kennedy played the long game to get to this point. He settled for positive but incremental reforms that nudged the system in the right direction and helped millions of people.

Importantly, these reforms helped, little by little, deepen the norm that healthcare is a right and not a privilege. He built a consensus around codifying this principle for the most vulnerable for whom denial of care was the most morally indefensible: those with emergency illnesses (under EMTALA) and children born without access to care (CHIP). He extended this principle to those most consistent with traditional American notions of virtue and sympathy: working families who had suffered job loss (COBRA).

With these precedents under his belt, it was just a short leap to extend this principle to virtually all Americans under the ACA. If the most vulnerable have a claim to healthcare as a right, why not everyone else? By 2009, this sensibility had become commonplace, and the ethos behind Kennedy’s slew of small-scale healthcare achievements made it much harder to deny granting the right to healthcare to the rest of the country.

The arc of Kennedy’s achievements on healthcare has important lessons for liberals aspiring for greater social reform. Compromise is a virtue not just because the good shouldn’t be the enemy of the perfect, but because positive compromise today can help deepen the principles that will get you closer to the perfect tomorrow.

Take an issue like poverty or income security. The idea of a basic income to secure a right from resource deprivation is resurgent on the left, with commentators and other countries increasingly pushing for a guaranteed income.

Perhaps this is a worthy vision to aspire to. But we are far away from a basic income being a plausible political reality in the United States.

Instead, liberals should follow Kennedy’s lead and start by providing income security for the most vulnerable and politically sympathetic: to those whose lives are in imminent danger from their poverty, like the chronically homeless and hungry; to children who were born into poverty through no fault of their own; and to working families who did everything right but fell on hard times due to job loss.

To provide help poor children, we could enact a child allowance—a common social benefit provided in Canada and much of Europe. This benefit could start out by focusing on the youngest children who are most severely harmed by spells of poverty, as some have already proposed.

For working families and those out of work, we could enact a host of policies to enhance their economic security: wage insurance to cushion them from a cut in pay or a change in jobs; periodic pay subsidies for low-income workers to boost their purchasing power and compensate for wage stagnation; and more robust unemployment insurance to keep both families afloat during bouts of joblessness and the economy stabilized during recessions.

And for the destitute, the homeless, and the hungry, we must provide an adequate safety net to prevent them from going without shelter and from suffering without nutrition. This may be the most difficult reform to channel political energy behind, as the poorest of the poor have virtually no voice in our politics. Moreover, unlike being stricken with emergency illness, few Americans see themselves as at risk for deep and severe poverty. Nonetheless, there is a clear moral imperative to provide more comprehensive protection from life-endangering poverty.

Some of these initiatives can build off of existing programs. The Child Tax Credit could be converted into a child allowance by making it fully refundable without income thresholds and by providing families with a periodic payment option. Similarly, the Earned Income Tax Credit can be transformed into a wage subsidy via a periodic government check or direct deposit that acts as a work bonus.

Each of these initiatives would be a tremendous achievement in its own right. Fewer children would grow up in deprivation; fewer families would be set back by job loss; and fewer people would go without basic food and shelter.

But collectively, they would also stitch together a series of programs reflecting a principle in favor of basic income security and freedom from need. Slowly but surely, we’d move closer both in practice and principle to a norm that demands a guaranteed level of basic resources for all.

Indeed, Kennedy’s health reform efforts—the “cause of [his] life”—fit into this narrative as well. Universal healthcare is ultimately about security in our lives, bodies, and resources. The right to healthcare is, at a fundamental level, the right to personal security. We can follow Kennedy’s long game and pick up where the Senate’s lion left off.


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