Kennedy’s Healthy Year
Veteran Sees a Bevy of Bills That Could Pass Congress
Sen. Edward Kennedy (D-Mass.) took up the family trade of politics at age 30 and is still at it more than four decades later. He was in the Senate when it passed legislation creating Medicare and has been a pivotal player in health care matters since then.
In an interview with Roll Call Executive Editor Morton M. Kondracke, he displayed his signature passion and outrage over the state of health care legislation. As chairman of the Health, Education, Labor and Pensions Committee, he plays a role as a big-picture player and pragmatic insider. In the interview, he handicaps the prospects for many of the bills that will see action this year: mental health parity, food safety and health IT.
Kennedy, who has pushed for universal health care, is even more excited about the prospect of a Democratic president to help make that happen.
ROLL CALL EXECUTIVE EDITOR MORTON M. KONDRACKE: What realistically can Congress get done on the health care front this year?
SEN. EDWARD KENNEDY: Well, there are a number of things that are very important and that hopefully we’ll still be able to get done. I put mental health parity probably at the top of the list. I think that’s enormously important. I think that there’s still a decent chance in terms of tobacco legislation. We’ve got the health disparities legislation that’s set up to move ahead. I think the genetic discrimination that’s been held up will still move. I think that’s important to support. We’ve had two votes on it; one 98-0, and the other was, I guess, 97-3. That’s being held up with the threat of filibuster, but I think we’re prepared to move ahead on that. There’s a chance in terms of small-business health insurance reform. We’ve got a good bipartisan group that’s meeting, trying to deal with this issue. It went quite a ways with the [Sen. Mike] Enzi [R-Wyo.] bill in the last Congress.
ROLL CALL: Which is association health plans?
KENNEDY: Well, it’s a very significant modification of that concept. His bill had some real pre-emptions of state law in it. And it has enormous disparities in the cost between healthy patients and those that have health needs. So, we’re in bipartisan discussions and debates on those. We had hoped that we could have the biologics, which was a very, very important concern. We spent a good deal of time with that. We worked out a compromise, but it wasn’t completely satisfactory to any of the particular groups, but it seemed to me to be about …
ROLL CALL: That is allowing generic copies of biological drugs?
KENNEDY: Generic biological alternatives could have important impacts in terms of costs and availability and accessibility. By nature, biologics are different obviously than normal drugs because of their molecular makeup, and it’s somewhat more complex and difficult. But I think you can look back over what we did and Hatch-Waxman [the 1984 law opening the way for the sale of generic copies of prescription drugs] and others which have been successful. We’re going to have to move along in these areas. Food safety [legislation] is very important, and we are working with the [Food and Drug Administration] on that proposal. We had some important features — food safety and the FDA reform. We’re going to have an enhanced program, and we’ve talked to [FDA Commissioner Andrew] von Eschenbach [recently].
ROLL CALL: This is to inspect food coming into the country?
KENNEDY: Coming in, and recall power — and really permitting the FDA to have the real authority to deal with these issues. There is some sentiment in the Congress that we ought to restructure the whole food safety program, take it away from the FDA and have a different agency. I’m not there. The FDA has about 80 percent of all food safety, divided with the Agriculture Department. I think there are different rules that apply, in the different food safety areas. I think they have to be coordinated, consolidated, upgraded. That’s very important. We have the implementation of the FDA legislation that we passed last year that has a very strong post-marketing surveillance program, which will expedite the whole consideration of various drugs because we’ll have a great deal more of information that can be used in order to protect the public. And that ought to have some impact in terms of cost, and getting good drugs on and getting bad drugs off. That’s something that’s enormously important.
ROLL CALL: What about health information technology legislation?
KENNEDY: Well, we have passed the health IT in the Senate, unanimously, and it got caught up in the last Congress, in various [House] committees. It is moving along. Our committees [Health, Education, Labor and Pensions] looked at it. Also the Finance committees looked at it. There are features of it relevant to the Judiciary Committee, and [Chairman Patrick] Leahy’s [D-Vt.] got a number provisions that concern privacy, which could slow this down because we’d have to sort of work out the possibilities. In terms of the savings [from IT], you’ve seen them — $160 billion a year. If you look at what’s happening, even up in Massachusetts, the savings are just incredible. The question is, who is going to benefit from the savings, and the initial outlays — how are we going to help smaller practitioners? I mean, give practitioners in smaller communities the wherewithal to move on into the IT.
ROLL CALL: Just let me stop you there. If there’s one thing that everyone across party lines can still agree upon, it is that health records ought to be digitized. This has been in agreement for five years. And, where are we?
KENNEDY: It’s well, as we passed it unanimously. It was an Enzi-Kennedy-Frist-Clinton bill, and we sent it over and it’s divided into three different committees in the House under the Republicans. This is the old bill that we passed that held up in the [Energy and Commerce] Committee. [Former Rep.] Nancy Johnson [R-Conn.] held it up when it had another go-through. All three subcommittees that had dealt with it had refused to move it along. All wanted a piece of it, all wanted a part of it. Then we reintroduced it this time, and it moved it along but everybody has tried to add more and more things to it. Everybody sees that this is a new concept. Everybody wants to have their fingerprints on it. Rather than putting it in place and letting it grow, everyone has been tampering around with it. I’m still very hopeful that we can get it and get it fast.
ROLL CALL: How’d this happen? It passed your committee, right?
KENNEDY: It’s out of our committee. It’s now at Judiciary Committee on privacy provisions. They had some jurisdiction on privacy. And I’m hopeful that we’ll get this thing done. We should get it done. There are some that think that the savings that are in there would be enormously important with a Democratic president implementing a universal health coverage.
ROLL CALL: The Democratic candidates and even [Sen. John] McCain [R-Ariz.] are counting on health IT to introduce savings.
KENNEDY: I much admire John, but his health reform is not going to get us there. Quite frankly, it’s an awful lot of restatement and rehashing a lot of the existing administration health programs, which I just don’t see getting us there.
And can I mention the international AIDS program, which they just got a broad, broad expansion of it. It needs reauthorization. There will be an important debate and discussions because of abstinence provisions [favored by the Bush administration]. A few others feel very, very strongly about the continuation of it in the international community and [others] have questioned those provisions. [Sen. Dick] Lugar [R-Ind.] has important recommendations that are certainly compromise visions that very well may be a pathway toward the reauthorization.
ROLL CALL: And the prospects for that are?
KENNEDY: I think they’re fairly good. There’s a lot of conversation and talking on this now. And that’s enormously important.
ROLL CALL: One thing you did not mention is the State Children’s Health Insurance Program. The administration budget contains $19.2 billion, and I’m told that they can even go to $25 billion, which is not far from the $30 billion that the Democrats were asking for last year.
KENNEDY: It is an increase in the funding, and I think there may very well be an opportunity for a vote on it later in the year. But, you know, we’ve got a sort of sufficient carry-on now through the fall. It may be revisited. But the general kind of debate and the discussion that was had last year — the administration has soured the whole context. Remember, this whole program was a compromise to begin with. Complete reliance on the private sector, which was an alternative to the Medicaid program, was the compromise. That program had been compromised, and that’s why George Bush had given it such strong support. And it was under the administration, under this Republican administration, that states grabbed at the waivers to include adults. And then when we came back, and said, OK, we’ll gradually phase out the adults but permit the states —which had been the Republican position — to have some flexibility to go above 200 percent of poverty, the administration said, “No way.”
ROLL CALL: Do you think health care is going to be the issue of 2009?
KENNEDY: Yeah, yeah clearly. It’s basically the issue whose time has come. It has the same feel that we had when I was here, going back a long time ago with Medicare. We failed in ’64, passed in ’65. The principal difference was the election. That was eight months difference, a switch of about 15 Senators, just absolutely switched their votes on the basis of the election of ’64. We failed in the spring and passed it in the late winter.
ROLL CALL: That was a Democratic landslide.
ROLL CALL: Do you need a Democratic landslide this year in order to pass comprehensive —
KENNEDY: No, no, I just think we need additional Democratic votes in the Senate and a Democratic president that wants to lead them.
ROLL CALL: I wanted to ask you some questions about what the Republicans say they would like to do, including the president and John McCain. That is, to do away with the tax discrimination given to people who get their insurance through their employers and those who don’t. The president offered a standard deduction. Some people say that there should be a tax credit. Democrats don’t seem to welcome this idea — but you think it would be something that Democrats would like to see.
KENNEDY: Well, the point about it is — what is this going to be an impact in terms of the fact that you have 160 million people that [get insurance from their] employers under the existing system? You have to look at both the tax and its impact, and you have to think about where you want to end up, rather than start indiscriminate chipping away at the current system.
ROLL CALL: You think that would undermine the employer-based system?
KENNEDY: There’s no question that it would. It may very well. Now, you’re going to alter and change the current system, and it does seem to me that you’re going to have to look at it in a way that’s going to be comprehensive. The idea that you’re going to have to deal with a multifaceted approach for health care reform that includes both cost and coverage, but also include preventive care, information technology, case management and evaluations of different techniques, demonstrating that they’re going to be efficacious. You’re going to have to consider individualized medicine. I mean, when you’ve got 60 or 70 percent of prescription drugs that have no impact whatsoever on individuals, we have to have a review of what is effective. But you have to look at the system. And then you’re going to have to look at the incentives to get them there, rather than the other way around.
ROLL CALL: Is it possible to give 47 million people who are now uninsured federal employee, Senate-style insurance at $100 billion a year? Isn’t it going to cost a lot more than that?
KENNEDY: We have to have a universal coverage. I started on this 38 years ago — we could not do it because it was going to cost $100 billion to have the whole system under a single payer. We’re up to $2 trillion on this now. $2 trillion. It was going to be $100 billion then, now it’s $2 trillion.
ROLL CALL: What?
KENNEDY: The whole system. It’s up $800 [billion] or $900 billion in the last five to six years. So everything is going in the wrong direction. We have some of the best hospitals and the best doctors in the world, but we haven’t got a health care system. And it’s measured in the fact that people are, 47 million [of them], going to the emergency rooms, at close to $500 a whack, which discourages people from going. Our infant mortality rate, are, all of the international health indicators show us [is not the best].
ROLL CALL: Just one last thing. I have read the criticism of both the [Illinois Democratic Sen. Barack] Obama plan and the [New York Democratic Sen.] Hillary [Rodham Clinton] plan, that there is no definite cost-control system. In the first Hillary plan, there was a universal budget — there is no guarantee that this thing is not going to blow the top off the budget?
KENNEDY: Yeah, well, I don’t think it is. I mean, if you look at what’s happening now in Massachusetts — a 28 percent reduction in free care. We had a 28 percent increase — 340,000 people that were uninsured that have been insured. And we are at about 60 percent of the national increase in cost, but we were about 60 percent above [the national average] prior to the health care reform. So, we are getting real savings. It’s beginning to work. It’s been in effect now for 14 months. For everyone who is paying for health insurance, a third of your health insurance premium is being used to cover somebody else, to start. And the wastage in the system is just breathtaking. And you know, there’s 80 million people who lose insurance at some point over the year — even if people have it, it’s inadequate. It’s what’s in people’s minds, and what they anticipate. Businesses know that they cannot compete internationally. There’s an entirely different mood among the consumers and among the businesses and among the health professionals and policy people. Language has changed completely. People are talking, saying stuff — people would get up and walk out of the room. They’re all now talking about these things. And the basic ideological aspects that set people apart, we’re seeing, are beginning to melt. And that is what is necessary in order to get the system in place.
ROLL CALL: Will that happen on the federal level?
KENNEDY: Well, that’s why we’re for Barack Obama.