All of us lost a great friend and champion with the death of Sen. Edward
Kennedy last month. As a new observer of the national political scene from the
Washington, D.C., perspective, I asked Nick Meyers of our Department of
Governmental Relations to coauthor this column.
Personally, I was struck by the outpouring of sadness and affection at the
passing of the senator. In an era of strident politics, the bipartisan
tributes to him were particularly notable—it isn't very often that you
find a staunch conservative like Sen. Orrin Hatch of Utah talking about the
good works of a friend on the Democratic side of the aisle in the Senate.
Although Sen. Kennedy's personal life was at times chaotic, he overcame
losses and adversities, turned outward professionally, embraced his career,
and devoted himself to public service.
And what a remarkable career it was. He focused on improving the lives of
millions of Americans who were poor, disabled, often politically voiceless,
and in desperate need of a champion. They found their voice in Sen. Kennedy.
And so did we.
These are among Sen. Kennedy's achievements that have been important to us,
to cite just a few:
These are extraordinary achievements by any standard. They are also
testament to the remarkable political skills that Sen. Kennedy brought to bear
on the issues he cared about. Nowhere has this been more evident than in his
tenacious, relentless struggle to end discrimination against patients seeking
treatment for mental illness and substance use disorders, culminating first in
the dramatic override of President Bush's veto of the Medicare reform bill and
then in the enactment of last year's "parity law" (The Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
With the passing of Sen. Edward Kennedy last month, mental health
advocates have lost a passionate ally. The photo above was taken in February
2003 at a press briefing announcing the introduction of the Sen. Paul
Wellstone Mental Health Equitable Treatment Act, a later version of which
became law in October 2008. Looking on are (from left) Rep. James Ramstad
(R-Minn.), Rep. Patrick Kennedy (D-R.I.), and Sen. Pete Domenici
Credit: David Hathcox
Regarding the Medicare bill, APA (and all of medicine) was very active in
the effort to get it through, since it included major improvements in coverage
of treatment of psychiatric illness, such as the phasing out of the 50 percent
coinsurance requirement that has been a feature of Medicare since the program
started in the 1960s. Despite our success in getting both the House and Senate
to pass this and other APA-lobbied mental health improvements, the Senate was
unable to muster the 60 votes needed to cut off debate on the bill and
override the president's earlier veto.
We knew from our excellent Capitol Hill sources that enough Republicans
were eager to vote to override the Bush veto, but only if the Democrats could
find the 60 votes, and they were one vote short, with Sen. Kennedy back home
recovering from brain cancer surgery. How frustrating to come so close to
enacting major improvements in Medicare that APA has sought for decades and to
be one single vote shy of success—one vote shy, that is, until Sen.
Kennedy stunned onlookers as he strode into the Senate chamber, asked the
clerk how he was recorded, and cast his "aye" vote in a clear
voice, cutting off debate and allowing the Senate to proceed—as we knew
it would—to override the president's veto. It was an astonishing moment
of political theater. Great theater, true, but it was far more than that as
evidenced by the long-standing ovation Sen. Kennedy received from his peers in
both political parties as they crowded around him to shake his hand and pat
him on the back in an outpouring of affection that has been extremely rare in
the Senate chamber.
So too was Sen. Kennedy the key player in the effort to pass a
comprehensive new "parity" law in the wake of the limited success
of the 1996 Mental Health Parity Act. Despite overwhelming and bipartisan
support for a broad new parity law, and despite the combined lobbying effort
of APA, the AMA, and the entire mental health community, we remained stalled
until Sen. Kennedy took the reins in the wake of Sen. Paul Wellstone's
untimely death and brought his consummate political skills fully into
Kennedy realized that no amount of cajoling would steer the bill through
the Senate as long as the business and insurance groups were opposed to it. He
and Sen. Pete Domenici (R-N.M.) set up a working group of business, insurance,
mental health professionals (APA included), and patients and charged us with
working out a compromise that we all would support. He drafted an initial bill
that he knew represented the boundaries that could win Senate passage, and
then he set the groups talking and negotiating, with key Kennedy and Domenici
staff coordinating the effort.
Then Sen. Kennedy set one inflexible requirement: everything was on the
table but no change would be accepted unless all of the groups "at the
table" agreed to it. The process was arduous. First the parity advocates
and the business and insurance groups had to learn to trust each other, not an
easy step. At times the negotiations seemed to be heading backward. Certainly
there were significant disagreements—sometimes even within the mental
health groups—but the senator kept pushing, cajoling, and reprimanding
as necessary to keep the groups at the table and talking. The final result was
the bipartisan passage of a major advance in ending discrimination against our
patients. It was also a firsthand lesson in how skillful a politician Sen.
Even as he knew he was dying, Sen. Kennedy was still pushing to better the
lives of Americans with a comprehensive overhaul of our woefully outdated and
inadequate health care system.
APA members, and particularly our patients, owe the senator a very great
debt. He will be missed, but his presence remains in the good works he leaves
behind—a record of compassion and achievement that few who have served
in the Senate have matched or ever will. ▪