Given the multitude of approaches to health care reform, feelings in Congress ran deep, Gephardt told us. Just a week earlier, he had held a health care meeting in his House office in which two members of Congress disagreed so violently that they nearly came to blows. Gephardt was emphatic that our best hope for passage was to attach health care reform to a budget bill known as the Budget Reconciliation Act, which Congress usually voted on in late spring. “Reconciliation” combines a variety of congressional budget and tax decisions into one bill that can be approved or disapproved by a simple majority vote in the Senate without the threat of a filibuster, a delaying tactic often used to kill controversial legislation, which requires sixty votes to break. Many budget items, particularly those relating to tax policy, are so complicated that debate can endlessly tie up proceedings in the full House and Senate. Reconciliation is a procedural tool designed to move controversial tax and spending bills through Congress. Gephardt was suggesting that it be used in an unprecedented way: to legislate a major transformation in American social policy.

  Gephardt was sure that Republicans in the Senate would filibuster any health care package we put forward. He also knew that the Senate Democrats would have trouble mustering sixty votes to stop it, given that Democrats held only a fifty-six to forty-four advantage.

  Gephardt’s strategy, therefore, was to circumvent a filibuster by putting health care reform into the budget reconciliation package. A simple majority would be required to pass the bill, and Vice President Gore could cast the tiebreaking fifty-first vote, if needed.

  Ira and I knew that Bill’s economic team inside the White House would likely reject a budget reconciliation strategy that included health care because it could complicate the administration’s efforts on the deficit reduction and economic plan. We broke up our meeting, and I took Gephardt straight to the Oval Office to make his case directly to Bill.

  Bill was convinced by Gephardt’s argument and asked Ira and me to explore the idea with the Senate leadership.

  Armed with Gephardt’s suggestions and Bill’s encouragement, Ira and I trooped up to Capitol Hill the following day to meet with Majority Leader George Mitchell in his office in the Capitol. This was the first of hundreds of visits I made to members of Congress over the course of health care reform. Mitchell’s soft-spoken demeanor belied his toughminded leadership of the Senate Democrats. I respected his opinion, and he agreed with Gephardt. Health care would be impossible to pass unless it was part of reconciliation.

  Mitchell was also nervous about the Senate Finance Committee, which would otherwise have jurisdiction over many aspects of health care legislation. He was particularly worried that committee Chairman Daniel Patrick Moynihan of New York, a veteran Democrat and a skeptic about health care reform, would react badly to the plan. Moynihan was an intellectual giant and an academic by training―he had taught sociology at Harvard before running for the Senate―as well as an expert on poverty and family issues. He had wanted the President and Congress to take up welfare reform first. He wasn’t happy when Bill announced his one-hundred-day target for health care legislation―and he let everyone know it.

  At first I found his position frustrating, but I began to understand. Bill and I shared Senator Moynihan’s commitment to welfare reform, but Bill and his economic team believed that the government would never get control of the federal budget deficit unless health care costs went down. They had concluded that health care reform was essential to his economic policy and that welfare could wait. Senator Moynihan anticipated how hard it would be to get health care through his committee. He knew he was going to be responsible for shepherding Bill’s economic stimulus package through the Finance Committee and onto the Senate floor. That in itself would require extraordinary political skill and leverage. Some Republicans were already publicizing plans to vote against it, no matter what it contained. And some Democrats might need convincing, particularly if the package involved a tax increase.

  We left Mitchell’s office with a clearer sense of what needed to be done, particularly on reconciliation. Now we had to convince the economic team―notably Leon Panetta, Director of the Office of Management and Budget―that including health care reform in reconciliation would serve the overall economic strategy the President was pursuing, not divert attention from the deficit reduction plan. Bill only had so much political capital to work with, and he had to use it to get the deficit down, one of his central campaign promises.

  The thinking in some quarters of the West Wing was that Bill’s focus on health care would divert Americans from his economic message and muddy the political waters.

  We also had to convince Senator Robert C. Byrd of West Virginia that health care reform belonged in reconciliation. The Democratic Chairman of the Senate Appropriations Committee, Byrd had served in the Senate by then for thirty-four years. Stately and silver-haired, he was the unofficial historian of the Senate and a parliamentary genius, famous for standing in the well of the chamber and dazzling his colleagues with quotations from the classics. He was also a stickler for procedural rules and decorum and had invented a procedural hurdle called the “Byrd rule” to ensure that items placed in the Budget Reconciliation Act were germane to budget and tax law. Democracy was undermined, in his view, if reconciliation was cluttered with bills that had little to do with passing the nation’s budget. Health care, arguably, was a budget bill, as it affected spending, taxes and entitlement programs. But if Senator Byrd thought differently, we would need a waiver of his rule to allow the measure into reconciliation.

  Slowly, I was learning what a steep mountain we were climbing. In the absence of an overwhelming crisis like a depression, passing either the economic or the health care plan was going to be difficult; passing both seemed almost insurmountable. Health care reform might be essential to our long-term economic growth, but I didn’t know how much change the body politic could digest at one time.

  Our goals were simple enough: We wanted a plan that dealt with all aspects of the health care system rather than one that tinkered on the margins. We wanted a process that considered a variety of ideas and al lowed for healthy discussion and debate. And we wanted to adhere to congressional wishes as much as we could.

  Almost immediately, we hit turbulence.

  Bill had assigned Ira the task of setting up the process for health care reform, which turned out to be an unfair burden for someone who was not a Washington insider. In addition to the President’s Task Force, which consisted of me, the cabinet secretaries and other White House officials, Ira organized a giant working group of experts divided into teams that would consider every aspect of health care. This group, comprising as many as six hundred people from different government agencies, Congress and health care groups, and including physicians, nurses, hospital administrators, economists and others, met regularly with Ira to debate and review specific parts of the plan in detail. The group was so large that some members concluded they were not at the center of the action where the real work was getting done. Some got frustrated and stopped coming to meetings. Others became narrowly interested in their own piece of the agenda, rather than invested in the outcome of the overall plan. In short, the attempt to include as many people and viewpoints as possible―a good idea in principle―ended up weakening rather than strengthening our position.

  On February 24, we were dealt a blow that none of us anticipated. Three groups affiliated with the health care industry sued the task force over its composition, claiming that because I was not technically a govemment employee (First Ladies derive no salary), I was not legally allowed to chair or even attend closed task force meetings. These groups had seized on an obscure federal law designed to prevent private interests from surreptitiously influencing government decision making and usurping the public’s right to know.

  There was certainly nothing secret about hundreds of people participating in this process, but the press, which was not invited to meetings, jumped on the issue. If I was allowed in the meetings, the lawsuit claimed, government sunshine laws required that the closed meetings be opened to outsiders, including the press. It was a deft political move, designed to disrupt our work on health care and to foster an impression with the public and the news media that we were conducting “secret” meetings.

  Soon thereafter, we got more bad news, this time from Senator Byrd. Every Democratic emissary we could think of, including the President, had asked him to allow health care reform into reconciliation. But on March 11, in a phone call with the President, the Senator said he objected on procedural grounds and that the “Byrd rule” would not be waived. The Senate was permitted to debate reconciliation bills for only twenty hours, which he viewed as insufficient time on a health care reform package of such magnitude.

  It was just too complicated an issue for reconciliation, he told Bill. In retrospect and based on my service in the Senate, I agree with his assessment. At the time, it was a political setback that forced us to refocus our strategy and figure out how to get health care reform through the normal legislative process. Hastily, we held meetings with members of the House and Senate to nail down elements of the plan we would deliver to Congress.

  We didn’t see that Byrd’s opinion on reconciliation was a giant red flag. We were trying to move too quickly on a bill that would fundamentally alter American social and economic policy for years to come. And we were already losing the race.

  In this climate, and with Bill weathering controversies over gays in the military and his nominations for Attorney General, we savored any successes that came our way. In the middle of March, the House passed Bill’s economic stimulus package, and my staff and I decided to have our own small celebration. On March 19, about twenty of us gathered for lunch in the White House Mess. The room, with its oak-paneled walls, Navy memorabilia and leather-cushioned chairs, was a perfect setting for private conversation and as much laughter as we could muster. The gathering offered me a rare opportunity to let my hair down with trusted aides and speak my mind about whatever topic was under discussion. From the moment I set foot in the room, I could feel my mood lighten and my mind relax for the first time in days.

  Lunch arrived and we began sharing stories of our first few weeks in the White House. Then I saw Carolyn Huber enter the room. One of my longtime assistants from Arkansas who had come with us to Washington, Carolyn walked over to my chair and bent down to whisper in my ear. “Your father has had a stroke,” she said. “He’s in the hospital.”

  THE END OF SOMETHING

  I left the White House mess and went upstairs to call Drew Kumpuris, my father’s doctor in Little Rock. He confirmed that my father had suffered a massive stroke and been taken by ambulance to St. Vincent’s Hospital, where he lay unconscious in the intensive care unit. “You’ve got to come right now,” Drew said. I rushed to tell Bill and pack some clothes. Within hours, Chelsea, my brother Tony and I were on a plane to Arkansas for a long, sad trip home.

  I can’t remember landing in Little Rock that night or driving to the hospital. My mother met me outside the intensive care unit, looking drawn and worried but thankful to see us.

  Dr. Kumpuris explained that my dad had slipped into a deep, irreversible coma. We could visit him, but it was doubtful he would know we were there. At first I was concerned about taking Chelsea to see her grandfather, but she insisted and I relented because I knew how close she felt to him. When we went in, I was relieved that he looked almost peaceful. Since it would have been useless for the doctors to operate on his injured brain, he was not hooked up to the tentacles of tubes, drains and monitors he had needed after his heart bypass operation a decade earlier. Although a mechanical respirator was breathing for him, there were only a few unobtrusive drips and monitors at his bedside.

  Chelsea and I held his hands. I smoothed his hair and spoke to him, still clinging to a small hope that he might open his eyes again or squeeze my hand.

  Chelsea sat by his side and talked to him for hours. His condition didn’t seem to upset her. I was amazed at how calmly she dealt with the situation.

  Hugh arrived later that night from Miami and joined us in Dad’s room. Hugh started telling family stories and singing songs, especially the ones that used to get such a rise out of my father. One of his frequent tirades concerned my brothers’ taste―or lack thereof―in television shows. He particularly despised the theme song to The Flintstones.

  So Hugh and Tony stood on either side of his bed and sang that inane song, hoping to provoke some sort of reaction―“Shut that noise up!”―as it had when we were kids. If he heard us that night, he never showed it. But I want to believe that somehow he knew we were there for him just as he had been for us when we were kids.

  Mostly we took turns sitting next to Dad’s bed, watching the mysterious green blips on the monitors rise and fall, succumbing to the hypnotic whir and click of the respirator.

  The center of my turbulent universe of obligations and meetings contracted to that small hospital room in Little Rock until it became a world unto itself, removed from all concerns except the things that matter most.

  Bill arrived Sunday, March 21. I was so happy to see him and could feel myself relax for the first time in two days as he took charge of talking to the doctors, helping me think about the decision we would soon have to make about my father’s medical options.

  Carolyn Huber and Lisa Caputo had come from Washington with me and Chelsea.

  Carolyn was especially close to my parents. I had met her when I joined the Rose Law Firm, where she had worked for years as an office administrator. She had managed the Arkansas Governor’s Mansion during Bill’s first term, and we had asked her to come with us to the White House to handle personal correspondence.

  Lisa Caputo had been my press secretary since the convention. She and my father hit it off the first time they met when they found out they were both from the Scranton-Wilkes-Barre area of Pennsylvania. “Hillary, you did real good,” my dad told me. “You hired someone from God’s country!”

  Harry Thomason flew in from the West Coast, and he also made travel arrangements for Virginia and Dick Kelley, who had been out of town and who arrived at the hospital Sunday night. Bill and I thought they had been in Las Vegas, their favorite destination.

  But Harry pulled Bill and me aside to deliver more tragic news. He told us, as gently as he could, that Virginia and Dick had not been in Nevada for a vacation. They had been in Denver, where Virginia was exploring experimental treatments for the cancer that had returned and spread after her mastectomy two years before. She did not want us to know how sick she was, and Harry said she would deny it if we confronted her. Harry had tracked them down, and he felt it was something we needed to know. Bill and I thanked him for his good sense and his good heart and rejoined Virginia and Dick, who were talking to my mother and brothers. We decided to respect Virginia’s wishes for now; it was best to deal with one family crisis at a time.

  The day after he arrived, Bill had to fly back to Washington. Luckily, Chelsea didn’t have to miss school because it was spring break. She stayed with me in Little Rock, and I was profoundly grateful to have her calm and loving companionship. As the hours dragged into days, Dad’s condition remained critical. Friends and family members began showing up from all over to lend their emotional support. To pass the time, we played word games or cards. Tony taught me how to play Tetris on his little handheld computer, and I sat for hours, mindlessly fitting together the geometric pieces as they floated down the screen.

  I simply couldn’t focus on my duties as First Lady. I cleared my schedule, and I asked Lisa Caputo to explain to Ira Magaziner and everyone else that they should go ahead without me. Tipper graciously stepped in on several occasions to attend previously scheduled forums on health care, and Al spoke in my place to leaders of the American Medical Association in Washington and presided over the first public meeting of the Task Force on National Health Care Reform. I just couldn’t leave my parents. Normally I am able to handle a great many things at once, but I couldn’t pretend that this was a normal time. I knew that our family would soon face the decision to remove my dad from life support.

  Perhaps to divert my feelings, in the long hours I spent in the hospital, I talked with doctors, nurses, pharmacists, hospital administrators and family members of other patients about the present health care system. One of the doctors told me how frustrating it was for him to write prescriptions for some of his Medicare patients, knowing that they could not afford to fill them. Other patients paid for their drugs but took smaller doses than prescribed, to make them last longer. Often, these patients ended up right back in the hospital. The health care policy problems we were tackling in Washington were now a part of my daily reality. These personal encounters reinforced my sense of both the difficulty of the assignment Bill had given me and the importance of improving our system.

  Bill returned to Little Rock on Sunday, March 28, and we gathered our immediate family together and met with the doctors, who spelled out our options: Hugh Rodham was essentially brain-dead, kept alive by machines. None of us could imagine that the fiercely independent man we had known would want us to keep his body going under such circumstances. I remembered how angry and depressed he had been after his quadruple bypass surgery in 1983. He had enjoyed good health for most of his life and valued his self-reliance. He told me then that he would rather die than be sick and helpless. This was so much worse, although at least he seemed to be unaware of his condition. Each member of the family agreed that we should remove him from the respirator that night after our final goodbyes and let God take him home. Dr. Kumpuris told us he would probably die within twentyfour hours.

  However, the soul of the former Nittany Lions football player and boxer wasn’t quite ready to leave. After the life support was removed, Dad began to breathe on his own, and his heart kept on beating. Bill stayed with us until Tuesday, when he had to resume his schedule. Chelsea and I decided to stay until the end.