The first time Sen. Edward M. Kennedy tried to add a prescription drug benefit to Medicare, the liberal Democrat from Massachusetts teamed up with then-74-year-old Sen. Strom Thurmond, the onetime segregationist from South Carolina. Their bill went nowhere.
Twenty-six years later, Kennedy, now 71, is still trying.
And although his party is in the minority, and he is not in the conference room where details are being hashed out, the fate in the Senate of prescription drug legislation now being negotiated rests largely in Kennedy's hands.
If enacted, the new legislation would create the largest expansion of Medicare in its 38-year history. An agreement from the conference committee of House and Senate negotiators could come as soon as this week.
Kennedy's pivotal role reflects both his longtime commitment to the issue and his equally long history of reaching across the aisle to work with some of Congress' most conservative members.
Even more to the point, his admirers and critics agree, was his personal assessment this year that he could achieve his policy goal -- prescription drugs for the elderly -- only if he compromised politically.
"With a Republican president and Congress, this is the best deal we're going to get," Kennedy said in an interview.
Some Democrats worry that his deal-making could make possible passage of a Republican-leaning bill that they believe would permanently weaken Medicare. None was willing to speak on the record about disagreements with the senator, but many have shared their concerns with him.
"He is a very positive force," Sen. Richard Durbin (D-Ill.) said of Kennedy's role. Asked if he thought Kennedy had given up too much in the Senate debate, Durbin said only: "This is a process, and that was a step in the process. What's important is what is in the final bill, and I want to keep an open mind about that."
Some of Kennedy's constituents are not so reserved.
Members of the Massachusetts Senior Action Council have met with the senator and flooded his offices with thousands of phone calls. Forty of them staged a demonstration outside his Boston office.
"We feel very frustrated with his position on this," said the group's president, Phil Mamber. "He got himself into a bind."
Conservative Republicans, meanwhile, fear that Kennedy will end up blocking their effort to transform Medicare from an old-fashioned, government-administered health-care program -- in which seniors choose their own doctors and hospitals while Medicare sets the fees and pays the bills -- into something that operates more like a managed-care plan in the private sector.
"Whatever he says is going to matter," said Joseph Antos, a health policy expert at the conservative American Enterprise Institute. "What people pushing for this don't want is for Sen. Kennedy to list five unacceptable things" about the bill.
In fact, Kennedy has whittled his list of unacceptables down to two or three -- but he harped on them a lot last week.
When pressed, however, he said there was only one provision that would guarantee his vote against a final bill: the House Republican plan to force traditional Medicare to compete with private managed-care plans.
"Yep," Kennedy said, without hesitation. "Putting a bull's-eye on Medicare is unacceptable."
It was clear early on, said Sen. Olympia J. Snowe (R-Maine), that "if you could get Ted Kennedy to support something and also get an initiative that Republicans could support, you really had the basis for the likelihood of success."
Snowe has pushed with Kennedy for compromise legislation that more closely resembles the Senate bill, which passed 76 to 21, than the House bill, which squeaked by on a 216-215 vote.
But several tentative agreements reportedly reached by House and Senate negotiators are similar to provisions in the House bill.
Rep. Bill Thomas (R-Bakersfield), chairman of the conference committee, who has said he must produce a bill that could pass both houses, appears to be gambling on getting 51 votes in the Senate. There are 51 Republicans in the Senate, 48 Democrats and one Democratic-leaning independent.
Given the numbers and Kennedy's stature, he has made his presence felt in the conference committee even though he is not a member. He and Thomas have met privately three times.
The Democrats could defeat a bill outright with only a few Republican defectors. And short of that, Republicans would need 60 votes to stop any filibuster.
Kennedy is "the elephant in the room," said a Democratic congressional aide familiar with the four-month-long negotiations.
At times, the liberal icon also has been the proverbial bull in the china shop.
Late in the night of June 25, with the Senate on the verge of passing its own Medicare bill, he threw a temper tantrum on the Senate floor. Shouting and red-faced, he threatened to block the vote if the Senate did not drop an amendment that, for the first time, would have tied Medicare premiums to beneficiaries' income.
Last week, after months of polite, back-channel politicking, Kennedy again rolled out the righteous indignation.
Perched in his memorabilia-filled hideaway office just steps from the Senate floor, he mocked Thomas' claim to have "buried" the private competition provision that Kennedy considers a deal-breaker.
Before cameras at a news conference, Kennedy bellowed, "What we are not prepared to accept is a special, juicy deal for the insurance companies or a raw deal for our senior citizens." Behind the scenes, he was doing his best to broker another compromise.
He plotted strategy with Senate Minority Leader Tom Daschle (D-S.D.). He attended 8 a.m. temperature-taking meetings with Sen. Max Baucus (D-Mont.) -- one of only two Democrats allowed by Thomas in the negotiations -- and other Democrats.
He buttonholed colleagues on the Senate floor. He wrote President Bush urging him to get more involved. And he had two "come to Jesus" talks with Senate Majority Leader Bill Frist (R-Tenn.).
Publicly, he rallied his Democratic colleagues to work against what he considered unacceptable Republican provisions. Privately, in an emergency meeting of Democrats on Thursday, he encouraged them to hold their fire, to "leave the door open" to potential Republican concessions.
Kennedy credits Daschle with keeping Democrats "more interested in the outcome than in making a political point" out of the Medicare issue.
Lawmakers from both parties began sharpening their rhetoric last week, framing their arguments for the debate to come.
"This is not just a fight to provide benefits to seniors for prescription drugs," Daschle said. "This is a fight now to save the Medicare system."
House Majority Leader Tom DeLay (R-Texas) indicated that Republicans would frame the Democrats as obstructionists if they filibustered the final bill or defeated it in an up-or-down vote.
"When you start seeing them draw lines in the sand ... we must be getting close" to succeeding, he said.
Kennedy appears to be at peace with the role he has played in helping to move the process this far along. "I'm prepared to take more of a chance than a lot of our colleagues are," he said, sitting on the edge of a yellow wing chair in an elegant Senate meeting room. "I came at this somewhat more open and flexible."
To get what he wanted, Kennedy agreed to a core provision in the Senate bill that gave private insurance companies the primary responsibility -- and the business -- of delivering the new drug benefit.
"That was the marriage," Kennedy said, twirling his glasses in his right hand.
But he is willing to go only so far to get a deal.
"We have already compromised to get to where we are," he said. And the bill's 10-year, $400-billion price tag "is a down payment."
With time closing in not only on this session of Congress but also on Kennedy's career, he very much would like his name attached to a major expansion of the Medicare program. Kennedy was first elected to the Senate in 1962, to the seat held by his brother, John, before his election as president.
After 41 years in the Senate, Kennedy's long view extends in both directions.
"I was here in 1964, when Medicare lost, and also in 1965, when it won," he said.
"But I also remember ... my brother talking about the Medicare program.... So Medicare, obviously, and health, generally, have been prime concerns that I've had since the time I entered the Senate."