When Carter finally agreed to a debate, the date was set for October 28, one week before the election, and we were delighted. The debate went well for me and may have turned on only four little words. They popped out of my mouth after Carter claimed that I had once opposed Medicare benefits for Social Security recipients. It wasn’t true and I said so: “There you go again . . .

We have been alienated by costs that soared beyond the means of all but the well-insured or wealthy; by specialization and the cold, quantifying approach that brushes past human concerns, and by the growing despair that comes from spending without regaining health. p. 244

This, then, is the human problem: there is a price to be paid for every increase in consciousness. We cannot be more sensitive to pleasure without being more sensitive to pain.

I spent six months in the hospital and five months in a Stryker frame—six months in all—when my back was broken, and I saw the dedication of the people. I knew it was costing a chunk of change for the insurance companies to cover my health insurance on it, but it didn’t present itself—the starkness, the compelling aspects—about the pocketbook. And that has never left me. That aspect of it I’ve been constantly exposed to in the time that I’ve been in the United States Senate, and I go back to it on many different occasions, on the different hearings or things that follow this. One very important set of hearings that I had in the Senate were the hearings in the—We’re getting ahead a little bit but it’s probably worthwhile pointing out because it’s close to this subject matter. In ’78, when we took the committee across the country, we tried to match up, in the hearing, the panel that we’d have. We’d have one panel and we’d have probably ten witnesses, but we’d group them so that there were five subject matters. We would have the way that the United States covered the particular illness, and the way the Canadians covered it, just to present to the American people the difference, you know, how the systems were in terms of real life circumstances. We’d have what were common experiences in the particular areas that families would be affected.

Well, maybe not death panels, exactly, but unless we start allocating health-care resources more prudently – rationing, by its proper name – the exploding cost of Medicare will swamp the federal budget.

Finally, we cannot have a fair prosperity in isolation from a fair society. So I will continue to stand for national health insurance. We must not surrender to the relentless medical inflation that can bankrupt almost anyone— and that may soon break the budgets of government at every level. Let us insist on real controls over what doctors and hospitals can charge. Let us resolve that the state of a family’s health shall never depend on the size of a family’s wealth. The President, the Vice President, and the members of Congress have a medical plan that meets their needs in full. Whenever senators and representatives catch a little cold, the Capitol physician will see them immediately, treat them promptly, and fill a prescription on the spot. We do not get a bill even if we ask for it. And when do you think was the last time a member of Congress asked for a bill from the federal government? I say again, as I have said before, if health insurance is good enough for the President, the Vice President, and the Congress of the United States, then it is good enough for all of you and for every family in America.

We’re confident that we should be able to deal with this. We have a situation where we have finite resources for infinite healthcare demands. Those are some factors contributing to the challenges we have,

I was aware of Harry Truman’s ’48 effort to try to get universal health care, and his disappointment, and that at least [Franklin D.] Roosevelt had looked at it in the ’30s and decided to go with Social Security rather than the health issue, and that it went back to Teddy Roosevelt’s progressive period, where he tried to move it along. So I knew the concept of the issue of national health insurance. I had heard enough, having been in the Senate during the ’64 battle, and in ’65, to know that we had taken a chunk of this but we hadn’t done the whole job. I had seen the success that they had had in ’64 and ’65 and thought that this was both a great opportunity and an area of very important need.

Someone has to care

When I was in Miami, President Carter was running for reëlection. I had interviewed Miss Lillian and the Carters’ sons when I was working in Columbus. There was going to be a press conference with him, and my news director assigned my male co-anchor to cover it. So I went to my news director and said, ‘Is there a reason why you asked Steve to do this?’ He didn’t even know he’d done it. I was, like, ‘I just want to make sure that you think about it the next time.’ ”

Carter found out that Califano and I were going to the same meeting, and he heard that they were just talking in general terms, and he became enormously suspicious of Califano. Califano never trimmed on Jimmy Carter’s principles. Wherever Carter came down, he stayed. You’d talk a little bit about it here and there, trying to glad-hand your bid on some of these kinds of things, which I understood. But he never trimmed, never played a game on that thing, and he stayed absolutely consistent. Carter fired him because he thought he was becoming too friendly with me on this, there’s no real question. And once he left—I mean, he was the only one who really understood the healthcare issue—it was gone. Eizenstat was, I thought, a positive. He wanted to be helpful in trying to bridge the gap. Califano didn’t want to have a split. It’s kind of interesting, in these notes, the extent that Jimmy Carter said that he didn’t want to have a split with us.

Nearly all the growth in the federal budget over the next ten years [2013-2022] is going to come from spending on healthcare and interest payments unless something changes. “You can’t fix this without doing health care,” says Paul Ryan. “I mean, health care is the driver of our debt.” And, as he and others routinely observe, even though the United States spends far more per person on health care than any other country, it isn’t close to having the world’s healthiest population.

This would threaten not just the health of Americans but also the strength of the American economy. Health-care spending already accounts for 17 percent of our entire domestic product. In other advanced nations, where the figure is around 10 percent, everyone has insurance and health outcomes that are equal or better than ours. This disparity undermines our ability to compete and succeed in the global economy. General Motors spends more per vehicle on health care than on steel.

I've heard the critics complain about the costs of change. I'm confident that at the end of the process, the change will be paid for—fairly, responsibly, and without adding to the federal deficit. It doesn't make sense to negotiate in the pages of NEWSWEEK, but I will say that I'm open to many options, including a surtax on the wealthy, as long as it meets the principle laid down by President Obama: that there will be no tax increases on anyone making less than $250,000 a year. What I haven't heard the critics discuss is the cost of inaction. If we don't reform the system, if we leave things as they are, health-care inflation will cost far more over the next decade than health-care reform. We will pay far more for far less—with millions more Americans uninsured or underinsured.