Kennedy leads renewed effort on universal healthcare

Presses for bipartisan support before new president takes office

Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the groundwork for a new attempt to provide universal healthcare, according to participants. The discussions signal that Kennedy, who instructed aides to begin holding the meetings while he is in Massachusetts undergoing treatment for brain cancer, intends to work vigorously to build bipartisan support for a major healthcare initiative when he returns to Washington in the fall.

Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration. Kennedy was an early endorser of Senator Barack Obama, the presumptive Democratic presidential nominee who is also a member of the Committee on Health, Education, Labor and Pensions, which Kennedy chairs.

Obama's Senate staff has attended the roundtable discussions. If Obama is elected, Kennedy's effort to identify points of agreement among senators could smooth the way for the new administration to press ahead on universal healthcare, which Obama has promised to implement within four years.

The last time a national healthcare plan was attempted, under President Clinton in 1993, the presidential panel charged with devising a proposal was widely criticized for not consulting enough with Congress, and protracted disagreements erupted, delaying its progress for months and ultimately resulting in its demise. Kennedy's effort appears to be designed to identify areas of common ground between Democrats and Republicans, business and labor, providers and insurers, and others before the new president takes office.

"The senator is trying to learn from health reform attempts in the past and to build a fair amount of consensus among his Senate colleagues, House colleagues, and the Obama campaign . . . and find a strategy that could carry with some momentum into the new administration," said Dr. Jay Himmelstein, a health policy specialist at University of Massachusetts Medical School and a former Kennedy staff member who has been involved in the talks.

The initiative also suggests that Kennedy, who has made healthcare his signature issue in his 45-year Senate career and who is fighting an aggressive brain tumor, is considering his legacy as a new administration arrives in Washington - a moment many see as the best chance for widespread changes in the healthcare system in 15 years....

Kennedy played a critical role in helping Massachusetts create a healthcare overhaul proposal in 2006 by aiding the state in obtaining the federal money needed to subsidize it. It appears he is now looking to Massachusetts to help shape the debate in Washington. Earlier this year, Kennedy recruited John McDonough, executive director of Health Care For All in Boston and a major player in the Massachusetts healthcare overhaul debate, to lead the new health initiative.

Aides to Kennedy have also assembled a network of Massachusetts advisers, including healthcare lawyers, economists, nonprofit leaders, doctors, and health insurers who may be asked to work on specific aspects of a national plan. At a recent meeting in Boston, the group discussed how different elements of the Massachusetts approach might work on a national level.....

Intraparty disputes were one reason Clinton's 1993 proposal foundered. Back then, Daniel Patrick Moynihan, the Democratic chairman of the Senate Finance Committee, dismissed the financing of Clinton's plan as "fantasy" just before the president presented it to Congress.....

Even though health costs have soared along with the number of uninsured over the past 15 years, the defeat of the Clinton health overhaul plan was so politically devastating to the administration and to efforts to enact universal health insurance law that nothing approaching such a large-scale effort has been tried since. One purpose of the roundtable discussions, participants said, is to educate Senate staff on broad issues that have not been seriously debated in years.

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Bad British teeth

The new NHS constitution outlined this week in the Darzi report promises an NHS accessible to all, free at the point of use, and provided on the basis of need, not ability to pay. No aspect of the service falls short of this ideal by a bigger margin than dentistry. The Health Select Committee, with a majority of Labour members, did not set out to spoil the NHS's 60th birthday. But its report certainly puts those promises into perspective.

For decades, most adults of working age have paid a substantial part of their dental costs - just the same kind of co-payment which, we are told, would undermine the whole ethos of the NHS if it were to be allowed in paying for cancer drugs. Yet in spite of this, NHS dentistry has a terrible reputation. Americans are said to recognise British people at 100 yards by the poor quality of their teeth. The old "fee per item of service" contract rewarded NHS dentists for the amount of drilling and filling they did.

The new contract was supposed to put all this right. But its implementation was left to a succession of junior ministers who never carried enough clout to make it work. The British Dental Association pulled out of the negotiations, but the Department of Health did not take the hint. It remained convinced it was right and brought in the new contract regardless. This simplified the scale of charges, but in such a crude way that it further distorted dental practice. No pilots were carried out to see if it worked. It would be all right on the night, critics were told. It was not.

The department and the Chief Dental Officer remain convinced that these are, well, teething pains. Meanwhile, private dentistry has overtaken NHS dentistry in the number of patients treated, and millions who cannot afford to go private let their teeth deteriorate. Can NHS dentistry be rescued? It seems unlikely. But the attempt made by this Government has made a bad situation worse, at greater cost. Next time it should try listening to the dentists.

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