Teddy Kennedy: ‘The cause of my life’

It is a moment of both triumph and struggle for the now 77-year-old Massachusetts senator, who won the 1962 campaign and eight subsequent elections. Congress appears closer than at any time since Medicare was enacted in 1965 to passing a comprehensive health care bill. The health committee he chairs passed a reform measure this week after 60 hours of deliberation and votes on more than 200 amendments.

Meanwhile Kennedy has been largely confined to his home on Cape Cod, battling brain cancer that doctors warn will ultimately claim his life.

At this critical juncture for health-care reform, with so many competing voices vying for dominance, the one that’s missing is the most familiar of all.

“He wishes he could be here’’ Sen. Christopher Dodd, D-Conn., probably Kennedy’s closest friend in the Senate, told the committee just before it passed the measure on Wednesday.

It is not clear when Kennedy will return. Or if he ever will. He has not been on the Senate floor since April. He is rarely seen in public (though he was photographed in a wheelchair boarding his sailboat Mya early this week). He had brain surgery last summer that was described as a success, but still faced radiation and chemotherapy. His staff is very tightlipped about his medical condition and his prognosis.

Yet his fingerprints are all over the measure, as they are the institution in which he serves.

The Affordable Health Care Act — the Senate health committee’s offering — contains many bedrocks of Kennedy’s advocacy: A call for all Americans to obtain health insurance; a requirement that employers subsidize it; grants for individuals too poor to afford it; and the creation of a public insurance plan to compete with private insurers.

Hours after it passed, President Barack Obama, who was 15 months old when Kennedy became a senator, praised it from the Rose Garden and credited its success to “the unyielding passion and inspiration of our friend Ted Kennedy.’’

If members of Congress have a hard time picturing the Senate without Kennedy, it’s because virtually none have served without him. Only two of the House and Senate’s 535 members — Sen. Robert Byrd of West Virginia and Rep. John Dingell of Michigan — arrived in Washington before him. In the Senate’s 220-year history, only Byrd and former Sen. Strom Thurmond of South Carolina served longer.

Few names in politics stir as much emotion as Kennedy’s — not all of them charitable. The youngest of Rose and Joseph Kennedy’s nine children, “Teddy’’ lived for years in the shadow of his older brothers.

His failure to win the presidency, either because of his own shortcomings or other pursuits, often drew more attention than his accomplishments. His liberal politics have made him a favorite rhetorical target — and fundraising tool — of conservatives for decades. His heavy drinking and womanizing provided as much fodder for tabloids as political opponents.

Yet for all the derision and ridicule of Kennedy at GOP gatherings, he has worked successfully with dozens of Republicans to pass substantive, high-profile legislation.

“He’s genuinely loved in the Senate, even by Republicans,’’ said Peter Canellos, who has written about Kennedy for two decades for the Boston Globe and is the editor of “The Last Lion: The Fall and Rise of Ted Kennedy,” written by members of the Globe staff.

“For half a century, he has been the dominant legislator in four areas: health, education, civil rights and immigration. If you look at all that’s been accomplished in those areas … his legacy is equivalent to a presidential legacy,’’ Canellos said.

With five committees working on the health bill and lawmakers trying to resolve seemingly irreconcilable differences before their August break, advocates of comprehensive reform say Kennedy’s ability to bring people together through his understanding of the issue is exactly what’s needed.

Ralph Neas, chief executive officer of the National Coalition on Health Care, first encountered Kennedy in the early 1970s while working as counsel for Edward Brooke, then Massachusetts’ other senator.

“His presence would have a very significant impact. He knows when to play hardball. He knows when to reach across the aisle. He understand the rhythms [of the Senate],” Neas said. “He’s a maestro.’’

The respect also comes from those who are not always on the same side.

Karen Ignagni, as president and CEO of America’s Health Insurance Plans, which represents private companies insuring more than 200 million Americans, has fought Kennedy over his push for a government-run insurance option and is well aware of his national reputation as a liberal standard-bearer.

“He also has the reputation as being one of the best consensus builders in the Senate,’’ Ignagni said. “He has demonstrated both a very strong view and grasp of all the substance involved in the issue. He has wonderful personal skills and he does his homework.’’

Kennedy’s passion for health care blossomed as a young senator. After a small plane carrying him to an event in 1964 crashed into an apple orchard, killing the pilot and an aide, Kennedy spent six months in the hospital recuperating from back injuries. Surrounded by doctors and first-rate treatment, “he realized that the Kennedy family, because of its money, had access and that most people don’t,’’ Canellos said.

It is a theme that would mark Kennedy’s public appearances for decades.

“As long as I’m a vote and as long as I have a voice in the U.S. Senate, it’s going to be for the Democratic platform plan that provides decent quality health care north and south, east and west, for all Americans as a matter of right and not of privilege,’’ Kennedy bellowed at a midterm Democratic convention in 1978, as frustration over President Jimmy Carter’s unwillingness to push for universal health coverage contributed to his decision to seek the presidency. Three decades later Kennedy used almost the same words during a tribute to him at the 2008 Democratic Convention.

It is hard to gauge Kennedy’s involvement in the day-to-day battle to get a measure passed. Numerous sources said Kennedy has been an active participant from his home in Hyannis Port and is in regular contact with staff and other senators.

Minutes after the bill emerged from committee, his staff posted a statement in which Kennedy noted that the caucus room in the Senate Russell Office Building where the committee has been meeting was the same place where two of his brothers — John and Robert — announced their candidacies for president.

“This room is a special place, and I believe our committee’s actions have added a glorious chapter to the honor roll of history that has been made here,’’ Kennedy said.

What goes unsaid is that if Kennedy were physically able, nothing would stop him from holding the gavel and personally ushering through what he has described as “the cause of my life.’’ His absence may have been reflected in the party-line vote his committee took last week, with 13 Democrats voting in favor and 10 Republicans voting against.

“He can build those coalitions and use those relations,” Canellos said. “Some of the people he’s deputized don’t have those relations.’’

Whether health care reform ultimately passes and whether Kennedy is able to return, his absence has forced many to confront what Washington will be like without him.

“He is the embodiment of the United States Senate,’’ Ignagni said. “The competence, the excellence and the leadership — that is Ted Kennedy. He is the heart of the Senate. And most people would say that on both sides of the aisle.”

Marc Sandalow teaches politics and journalism at the University of California’s Washington Center.