We've Lost a Champion

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 Act).

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 play.

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. Kennedy was.

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. ▪