This campaign season, Minnesotans have heard a familiar baritone narrating radio spots for gubernatorial candidate Tom Horner.

In one ad, the voice-over says, “The left-right divide in our politics is as big as the hole it’s created in our state’s pocketbook.”

In another, the voice says that too many Minnesota leaders “start from the left or the right, [but] rarely reach as far as the middle.”

If you heard the ads and were trying to place the voice, the mystery was solved halfway through: “I’m former U.S. Senator Dave Durenberger.” The name and the message resonate. Durenberger built a political career as a voice from the middle.

He was a Minnesota U.S. senator from 1977 to 1995. In his prime in the mid 1980s, he was the most approved-of Minnesotan in politics. He was re-elected twice by such comfortable margins that he seemed set to become a senator for life. But his political career crashed in the early 1990s due to ethical violations; he retired rather than seek re-election in 1994.

Two things are noteworthy for their omission from the radio ads. First, Durenberger does not mention that he is a Republican and has been one throughout his career. Second, he doesn’t mention that Tom Horner, who came up in politics as a Durenberger aide and also is a lifelong Republican, is the nominee of Minnesota’s Independence Party. The message is simply that Horner is “an independent candidate who can recognize a good idea from any side and put it to use for all sides.”

It’s emblematic of a shift in America’s and Minnesota’s politics that Durenberger’s Republican protégé is running as an Independent. The description of Horner in the ads is one Durenberger might have used about himself from firmly within the Republican party 25 years ago. As a senator, he supported ideas from across the aisle, bucked party orthodoxy, and generally operated from a politically moderate middle ground.

He still tries to, now as head of the National Institute of Health Policy (NIHP) at the University of St. Thomas in Minneapolis, which he founded in 1999. Durenberger still wants to shape policy—to lead, at least on certain issues. But that’s harder to do in an era when few seem willing to follow a moderate path.
 

On Health Care

“We’ll never come up with enough money to do the kind of education that this country and its free enterprise system and its world trade and everything else needs, we’ll never come up with the money we need to restore a great university in this state—whether you call it an investment or you call it taxes, whatever you want to call it—we can’t come up with the money if we don’t deal with health care” and the disproportionate dollars it consumes, Durenberger says.

That’s not the only way, but it’s the clearest and biggest-ticket way, he says, in which Minnesota and the country are hurt by the shrinking of the moderate middle in public debate.

He’s been an advocate of the Obama administration’s health care reform plan. Durenberger calls it a good bill—not ideal, but “full of good policy ideas.” It’s about as good as could be accomplished, given the constraints of current U.S. political culture and popular sentiment, he says.

“But given an opportunity to get to universal coverage and to reduce costs, which a lot of critics don’t believe this bill can do—but I do—they give it short shrift and say, ‘Let’s go with the repeal guy.’

“I’m just amazed,” he adds, “at the number of smart people, including business leaders, who can find something wrong with that health care reform bill before they’ve even looked to see what’s right about it, where the opportunities are, or what it would be like to go back to where you were before, with nothing being done.”

For one thing, Durenberger says, the new law’s provisions for demonstration and pilot projects have opened the door for a regional Medicare proposal that the NIHP made three years ago, “where Medicare would allow the six states in the Upper Midwest to run their own Medicare program. That would be really terrific.” It would allow doctors, hospitals, and other care providers “who generate huge savings for the Medicare system by changing the way we deliver care, to keep a portion of those savings,” he explains. Right now, gains made in this region may be offset by inefficiencies and losses elsewhere in the country. By regionalizing savings and losses, the NIHP means to incentivize improvements across the country.

Durenberger chaired the Health Subcommittee of the Senate Finance Committee beginning in 1980 and authored numerous pieces of health care legislation, culminating with the battles over reform under the Clinton administration, where he favored managed competition over government regulation as a means of improving the system. The current reform law has failed to make one key breakthrough, he says: U.S. health care is “still a fee-for-service system. It still does not reward performance. It’s still penalizing the conservatives,” by which he means those who get better results at less cost. That’s the area where the NIHP has worked hardest to effect change.

The institute declares itself “a neutral forum for multi-stakeholder collaboration” that will create “positive change in the health care policy environment.” Durenberger convenes its 30-some members, mostly Upper Midwest health plans and hospitals, for information-sharing purposes.

“Our modus operandi was never lobbying, but leading by example,” he says. Through forums and speaking engagements, one of the institute’s core objectives has been to keep Upper Midwest health care visible to the nation.

“We’re by far the biggest geographic region of the country that has a unique practice style, that honors health and high quality health care performance at a much lower cost than the national average,” he says, and cites a history of paying for performance rather than procedures that goes back to Minnesota’s early health maintenance organizations.
 

On Being a Minnesota Republican

Durenberger turned 76 in August. He divides his time between his home on St. Paul’s Crocus Hill and another in San Rafael, California. He and his wife, Susan Foote, have 12 grandchildren between them, ranging in age from 2 to 16. (Foote, a former member of his Senate staff, is also well-versed in the health care system and reform.)

Once a month or so, he issues a newsletter called Commentary from Dave Durenberger that spans health care, the economy, education, social change, the role of government. He does other writing occasionally and speaks on health care frequently.

He still calls his old colleagues, including some in the Senate, but he notices that callbacks don’t come as promptly as they once did.

Durenberger still considers himself a Republican, “a Minnesota Republican,” he says. He emphasizes the word to invoke a particular strain of moderate-progressive Republicanism that has dominated the state for most of its history. Minnesota began as a bastion of Lincoln-style Republicanism and gave its electoral votes to Lincoln in its first two presidential elections. No Democratic presidential ticket carried Minnesota until 1932. And even after it became reliably blue in national elections, the state elected moderate-progressive Republicans for governor, from Harold Stassen in the 1930s to Durenberger’s mentor, Harold LeVander, in the early 1970s to Arne Carlson in the 1990s.

“I believe I am a Republican, the kind of progressive Republican that has served Minnesota well,” Durenberger says. “I believe I am a conservative, not a liberal, and I can give you thousands of examples to back that up in the things I’ve advocated on health and everything else I’ve done. Consumer choice on health care, building the rules for a market that will work—I know where I am as a matter of principle on the role of government.”

But Durenberger finds himself out of step with his party now. In 2008, he openly supported Barack Obama over his former Senate colleague John McCain for president. That same year, he supported his friend Norm Coleman as the Republican candidate for Senate and wrote rather dismissively of Democrat Al Franken’s qualifications.

Even if he weren’t helping Horner run for governor, Durenberger would be hard pressed to support the Republican nominee, State Representative Tom Emmer, or a congressional candidate such as Michele Bachmann, whom he has ripped in his Commentary.

“These people are not Minnesota Republicans,” Durenberger says, referring to the party’s current leaders.

Given the economic and other problems that need solving, “it is upsetting to watch a business community go knee-jerk for guys like Emmer and whoever the Republican candidate for president might be because ‘they’re for cutting spending, they’re for cutting taxes,’” Durenberger says. “You just don’t get choices when it’s the far left or the far right, you don’t get choices. You’ve just got somebody who says they’re more closely aligned with your interests.”

“Dave Durenberger is looking back wistfully at the days of his youth and waxing nostalgic for the political system that prevailed when he came into politics in the 1970s,” says Tony Sutton, chairman of the Minnesota GOP. “The Republican Party is where the nation is, and the Minnesota Republican Party has changed because the state is changing. There are guys of his generation that just don’t get it.”

On Life After the Senate

Nobody starts out as an expert on how to be an ex-senator, Durenberger says. For 16 years, there was a big staff to carry out his wishes, lobbyists angling for a crumb of his time, and the feeling he could change the world for the better.

“There’s 12 people always surrounding you, telling you how great you are, and that’s all they ever tell you,” he says. Then suddenly, on the day you leave the Senate, “there is no spotlight. There’s no staff. There’s nobody kissing your ass. Yes, I missed it for a couple years, and then I got over it.”

They were tough years. His second marriage (his first wife had died) ended in divorce before he left the Senate. Legal bills had piled up while he defended himself against both Senate ethics charges and criminal charges stemming from the same actions (see sidebar below). The Senate also required that Durenberger pay back income connected to the ethics violations.

It took a while, but “I dug myself out of a really deep hole,” he says. He did it mostly by lobbying, first as a “door opener” (he expresses the term with distaste) with the Washington firm APCO Associates. Then he and Foote started their own lobbying firm.

That project required him to stay in Washington for a time, but he also laid the groundwork for a return to Minnesota and for a way to have a voice in public affairs. During his first post-Senate week, he started teaching an MBA class at the University of St. Thomas. He still teaches there, and in 1999, with an endowment supplied by Republican donors when he left the Senate, he started the NIHP.

Over time, he found a constituency of several thousand subscribers with his Commentary newsletters. In them, and in his health care work, and now in his endorsement of Horner, he is the same moderate—some might say maverick—that he was as a senator.

For instance, Durenberger was clearly offended by those who, in describing the Obama health care bill, used scare words like “rationing,” and said it would turn U.S. health care into “socialized medicine” like the system in the United Kingdom. In his newsletter, he noted that the U.S. already does ration health care:

“As in implicit rationing in the U.S. and explicit rationing in the U.K. In other words, in this country we simply make medical services for those who cannot afford them unavailable except in emergencies. In the U.K., the access rules apply to all Britons. They include limits on access to medical technology proven less effective and/or more costly than existing technology.”
 

And on the recession, there was this:

“The Wall Street Journal/American Enterprise economic axis uses Ronald Reagan’s unemployment recovery to justify tax cuts as the way to full employment . . . .The Carter-Reagan 1979–82 recession has one thing going for it. We learned how to live without inflation, and what it took to live with an excess of federal spending over federal revenue. Call it deficits. We learned that the only way to lower tax rates is to reduce tax spending . . . . But the ‘private sector’ learned how to preserve tax spending for borrowing, for individual savings accounts, for home ownership, for health insurance. The list goes on and on. Until the costs of an out-of-control banking sector to securitize it caused the crash of September 2008. We never did practice what Ronald Reagan preached: that a national policy of ‘having without paying’ raises expectations in producers and consumers that can’t last forever and will eventually corrupt us.”

When I say during our interview that his commentaries “reek of candor,” Durenberger’s face lights up. He is so tickled by the description that he makes a note of it, then publishes the quote, attributed to me, in the next edition of Commentary. The freedom to be that candid is one advantage of being an ex-senator and he relishes it.

“People who need to speak their minds, who need to tell you where they stand, can’t do it, because it’s box-checking time in the parties,” he says. Complicated issues are reduced to sound bites. “Citizens can’t find out what they need to know.”

On Leaders to Come

Durenberger is preparing to leave for a month on the West Coast when we talk. But first, he will go to the airport to pick up Dr. Naoki Ikegami, a top Japanese health care economist. This evening, Durenberger will introduce Ikegami at a meeting attended mostly by physicians and executives of health care companies, then moderate discussion after Ikegami speaks.

The topic: what Americans might learn from the way Japan handles health insurance. Japan is one of many nations that spend less on health care than the United States and have overall better results, as measured by the health and longevity of the population.

This is the kind of work Durenberger hopes will continue after he leaves the National Institute for Health Policy. He is gradually retiring from his post there, and has told the University of St. Thomas to search for a replacement.

It’s unclear what will become of the institute after he’s gone. Durenberger says that will depend on “generous givers.” St. Thomas has plans for the future of the NIHP, but needs “to raise the money to make it more of a permanent institution,” he says.

And what will Durenberger do after he leaves there? “The same things I’ve always done,” he says, but “put less time against it.” He wants to free himself for more research, for family, and “for fishing, traveling, and having a good time.”

There’s one more thing he’ll be working on whose outcome remains to be seen. “I try to use my time selectively to inspire leadership in this community,” Durenberger says. “I’m not prepared to talk about it in the specific, but we have what might be called ‘nontraditional potential’ for leadership on health care implementation in this community.” He doesn’t name names, but while dire prescriptions come from the political extremes, Durenberger says these are “people who I’ve tried to talk into being more optimistic than all the people around them.”

Party-line crossing and its decline in the U.S. Senate are easy to track. For decades, the Congressional Quarterly has tracked every vote on which the majority of Democrats and the majority of Republicans have voted in party blocks. The quarterly assigns each senator a “party unity” score based on how often that person has sided with his or her party on those party-line votes.

In 1979, Durenberger’s first year in the Senate, his party unity score was 50 percent. That’s right, the newly elected Republican senator sided with his party on only half of the party-line votes.

Over the next 15 years, his score ranged from a low of 43 percent to a high of 68 percent. But every year, it was substantially lower than the average for the Republican caucus—at least 10 percentage points lower and some years more than 20 points lower.

Today, the majority of senators vote with their party 90 percent of the time or more. In 2009, 72 percent of all the votes in the Senate were party-line votes, the highest portion in the 50-plus years that Congressional Quarterly has been keeping score.