A Few Minutes With Senator Kennedy.

Whether you agree or disagree with him, there is one thing about Senator Edward M. Kennedy (D-MA) upon which there is general consensus: He has been the U.S. Senate's spearhead on health, education and other social issues, for the past four decades. Media "folderol" aside, Senator Kennedy has been known as one of the hardest-working and best-informed public officials on Capitol Hill since his election in 1962. He led the national health insurance movement in the 1970s, and has since lent his efforts and, often, his name to groundbreaking healthcare legislation. His achievements include the Health Insurance Portability and Accountability Act of 1996, which makes it easier for those who change or lose their jobs to keep their health insurance, and the Children's Health Coverage Act of 1997, which makes health insurance more widely available to children through age 18 in all 50 states. Senator Kennedy is currently a leader in the effort to enact the Patients' Bill of Rights, aimed at empowering Americans to deal with managed care health plans and provide greater protection for patients and physicians in dealing with insurance companies. His involvement has not stopped with healthcare, however--education reform, minimum wage increases, strengthened civil rights laws, protections for people with disabilities, cleaner air and water, Social Security and Medicare reform--all of these major issues have borne Senator Kennedy's imprint. Recently, he offered his views on the current legislative state of affairs for healthcare, education and worker training--and how he views his own methods and legacy--in an exclusive interview with Nursing Homes/Long Term Care Management.

Hyatt: Would you give our readers an overview of how you approach policy development?

Senator Kennedy: If I see a problem, I try to get the best minds together to find a solution. I learn about problems in different ways--from constituents, from news reports, from state and local officials and through personal experience. In developing solutions, I reach out to policy experts, academics, business and labor leaders, state and local officials, and often many others, as well. The more input the better. Once a solution is developed, I try to line up support in Congress, using direct personal contacts and phone calls. I try to enlist grassroots support from community activists, public interest groups, state and local officials, and business and labor leaders.

I then work with the coalition and push ahead until we succeed. Sometimes it may take two, three or four years, but if we persevere, we can often eventually succeed and achieve the goal.

Hyatt: Which is more difficult: to enact new policies or to change existing policies?

Senator Kennedy: It's rare to find a vacuum waiting to be filled or a status quo without ingrained support. Sometimes an event occurs that has such a transforming impact that enacting a new policy or changing an existing policy happens quickly, without great effort. Other times, powerful institutional forces make it very difficult to make progress and enact a new policy or change an existing policy.

Hyatt: The Balanced Budget Act paved the way for progress in some areas, but it has caused chaos in the healthcare industry, especially among those trying to provide care with the resources allocated. Post-acute care providers such as nursing homes and home health were hardest hit, as evidenced by recent closures and bankruptcy filings. Of course, the real casualties in all of this are our senior population. What do you believe might stem the tide and remedy this situation?

Senator Kennedy: The cuts in the Balanced Budget Act turned out to be far deeper than Congress intended or expected. We made a down payment on undoing some of the damage in the Balanced Budget Refinement Act last year. This year, Congress must do more, and I am hopeful that we will be successful.

Hyatt: What would you suggest that healthcare providers do to help you and others in government to restore these funds?

Senator Kennedy: They need to get the word out to every member of Congress, in every district and state. Bach senator and representative needs to understand in concrete terms how failure to provide needed relief will harm healthcare providers in their districts and states.

Hyatt: What do you believe is the future of Medicare?

Senator Kennedy: Medicare is a specific promise between the government and the people. It says, "Work hard and contribute to the system during your working years, and you will have health security in your retirement years." Medicare is one of the most successful social programs ever enacted. It is as important today as when Congress approved it in 1965. Preserving, defending and improving Medicare is a continuing responsibility of both Congress and the administration.

Proposals that would partially or fully privatize Medicare are the wrong direction for its future, and I'm optimistic they'll be rejected.

Hyatt: As you know, staffing is of major concern to the long-term care industry. Are there new policies on the horizon that will improve the skills of the current work force and offer incentives to the organizations that employ them?

Senator Kennedy: Throughout our history, economic prosperity has depended on rapid adaptation to technological change. Congress has often been part of the process. A recent example is the Workforce Investment Act of 1998, which is intended to create an improved job training system for new and incumbent workers.

Under it, states will develop provider data systems to inform workers and employers of the state-of-the-art training in their local areas; the integration of related but traditionally separate employment and training programs is encouraged. A system is created that depends on accountability and performance measures to assess skill attainment; and the business community becomes closely involved on Workforce Boards, meaning that the same business leaders concerned about the shortage of skilled workers are now in a position to help define the training that workers will receive.

However, additional steps are needed to ensure the success of the act. We need to fund the system at a level that clearly reflects the high priority for improving the skills of the work force; we need to increase investment in community colleges and universities, which are the most direct connection between higher education and the work force. Customized courses can enable workers to obtain immediate skills in areas where employers are reporting shortages of qualified workers.

In addition, we need further incentives for employers to invest in increased training for their workers. For example, many companies have adopted on-site classwork, extra time to pursue academic and technical courses, and cash incentives for increasing occupational skills. We need to work with leaders in business, labor and higher education to make sure that promising practices like these are widely disseminated and replicated in industries across the country that are experiencing skills shortages.

Hyatt: Being an elected official can be a difficult and short-lived occupation. To what do you attribute your ability to be a "sustainable leader"?

Senator Kennedy: I try to focus on making a difference in people's lives. There is nothing more rewarding than meeting someone who was helped by something you did. It makes you want to work even harder.

Hyatt: What do you believe is at the core of your success?

Senator Kennedy: People inspire me. It's easy in the Senate to forget about the practical impact of the work we do. I try to think about the impact on people's lives, and keep the focus on what's important. For example, it's a scandal that Congress has failed for so long to provide prescription drug coverage for senior citizens under Medicare.

Hyatt: Considering all you have accomplished and that which is still to come, what type of legacy would you most like to leave?

Senator Kennedy: I hope my greatest legacy will be my children, my grand-children and what they do with their lives and for their country. Beyond that, I hope people will say I made a difference in the Senate and helped make America a better and fairer place.

Some of the most gratifying progress has been made in healthcare. From the establishment of neighborhood health clinics 30 years ago, to the Americans with Disabilities Act, to greater funding for health research, to the Kassebaum-Kennedy bill that protects people's healthcare when they change or lose their jobs, to children's health reform with Senator Orrin Hatch (R-UT).

One of the first bills I voted for was Medicare, and I've worked over the years to fight off repeated attempts to cut it or privatize it. Some of the most important votes I cast were on civil rights. That's what this country is all about: equal opportunity for everyone.

I would like to express my appreciation to Senator Kennedy, who so graciously offered his time and willingness to participate in this interview. As always, I would also like to thank the readers who write in support of this column. Ideas that you feel would be helpful to readers should be addressed to Laura Hyatt at: [e-mail]. Be sure to include your name, the name of your organization, address and phone number with area code.

Laura Hyatt, MBA, is president of Hyatt Associates and a member of the Business Faculty at Mount St. Mary's College.