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Bioethics Forum Essay

When Pat and Bob Nearly Saved Health Care Reform: A Lesson in Senatorial Bedside Manner

With Senator John McCain’s heroic return and Vice President Mike Pence’s tie-breaking vote on a health care bill July 25, Senate Republicans managed to cobble together 51 votes simply to agree to debate health care reform. This razor’s edge victory is diagnostic. Hyperpartisan debate is convulsive. It endangers the body politic and needs to give way to more tempered discussions across the aisle.

Just as doctors need to learn how to talk to patients, members of the Senate need to learn how to talk to each other again. And like young medical students, they can learn from those who have mastered the art.

For a quick course in senatorial bedside manner, I encourage both parties to recall a time when bipartisan health care reform nearly happened: when the late Sen. Daniel Patrick Moynihan (Democrat of New York) and Senate Minority Leader Bob Dole (Republican of Kansas) almost achieved the bipartisan compromise – which could have prevented our current troubles – during the debate over the Clinton plan in 1994.

I learned how central bipartisanship was to Moynihan from my research in the Daniel P. Moynihan Papers at the Library of Congress for a paper on the senator’s defense of academic medicine during the debate over health care. It was a central feature of his political biography. Moynihan had served in both Democratic and Republican administrations. This was despite his being a lifelong Democrat and old-fashioned liberal, as Greg Weiner, the author of “American Burke: The Uncommon Liberalism of Daniel Patrick Moynihan,” reminds us.

Moynihan’s willingness to cross the aisle was epitomized by his relationship with Dole. The two senators were good-faith adversaries and sometimes collaborators. Together they saved Social Security in an epic bipartisan deal in 1983 and passed NAFTA in 1993.

Moynihan and Dole’s attempt at collaboration speaks to their deep respect for the legislative process. Despite their differences, they appreciated the need to work across the aisle to achieve a consensus. They seemed to instinctively understand that anything less would be perilous. Senator leaders and the rank and file should reflect on this lesson. The notion of good-faith adversaries seems to have been lost entirely.

Indeed, Moynihan anticipated the demise of the Clinton plan, warning that laws as ambitious as health care reform “pass 70 to 30 or they fail.” The author of a monograph on secrecy in government, Moynihan also warned of crafting such massive legislation in secret, as Senate Majority Leader Mitch McConnell (Republican of Kentucky) has done.

As far back as the fall of 1993, expert Senate observers felt that health care reform, the top priority for the Clinton administration, was a nonstarter unless Moynihan and Dole worked together. As Haynes Johnson and David Broder observed in their brilliant volume “The System,” “For all their differences, Democrats and Republicans knew that if the Senate were to produce a health care reform bill, Moynihan and Dole would have to create it … no two men understood or appreciated each other’s abilities more.”

In an extended interview with me at his MSNBC offices several summers ago, Lawrence O’Donnell – who was Moynihan’s chief of staff on the Senate Finance Committee – told me of their constructive, and sometimes mutually beneficial, alliance. “It was quite normal to include [Dole] in these things before he became a presidential candidate.” At the staff level, O’Donnell and Sheila Burke, Dole’s chief of staff, were in routine contact to prepare for a bipartisan compromise.

Early on, both Moynihan and Dole spoke confidently that together they would get a bill through the Senate. They also both recognized that it would be over the objections of the far right and left. As Johnson and Broder recount, Dole was quick to add that “…even people on the far right and the far left get sick and need health care. And there are probably a lot of good conservative people out there without health care. And there are things we can do to make it better.”

Moynihan recalled their rapprochement in a letter to New York Times publisher Arthur Sulzberger. “On the morning of May 12, Bob Dole, Minority Leader, passed me a note. ‘Pat, Are we ready for the Moynihan-Dole Bill?’ I literally put down the gavel and rushed into the back room to call the White House.”

In his memoir, “Eyewitness to History,” David Gergen, a former presidential adviser, recounts President Clinton’s response. “‘As long as I am president,’ he said, ‘I plan to keep fighting for serious reform. I did not get elected to compromise on the issue. We can’t trust the Republicans and I am not backing down! We won’t compromise.’”

It was that simple, and Gergen knew it. He looked down at his watch and made a note to himself that “At 10:22 p.m., health care died.” He was right, and the lingering debate over Obamacare speaks to the prescience of that postmortem.

This, too, is a lesson for the current generation of political leadership.

So, what might have been the alternative history if Moynihan and Dole had their way and sought the compromise that continues to elude us? We can’t know for sure, but we do know what Moynihan hoped to bring to the table.

It was simple, elegant and eminently workable, as O’Donnell told me.

Moynihan shared his plan with O’Donnell during a Finance Committee hearing: “… he puts his hand over the microphone, as they do so they won’t be heard, and he leans over his shoulder to me and says ‘Why don’t we just strike the words over 65 from the Medicare schedule?’ And that was our health care reform idea.”

Whether or not Medicare for all is the solution on which leaders can agree, it is time to resurrect a bipartisan approach. To be sure, this may seem quaint given our current polarization, but what alternative do we have? Vice presidential tiebreakers on health care are not a sustainable model to govern 17.8 percent of our GDP.

It seems clear that neither the Democrats nor Republicans can do this alone. As the debate moves to more regular order, each party needs the other to succeed. The health of our people and our democracy depends on their shared success.

Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics, Professor of Medicine at Weill Cornell Medical College, codirector of  the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, and Solomon Center Distinguished Scholar in Medicine, Bioethics and the Law at Yale Law School, and author of Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness .  He is a Hastings Center Fellow and board member. This essay originally appeared in The Conversation.



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