PORTSMOUTH, N.H.
To appreciate the surprising decision by Edward Kennedy to support Al Gore for president before the first primary, it helps to go off on a vitally important tangent - life among the 14 million disabled people in this country.
Last year, with not enough notice, there was a major expansion of programs to help about half the disabled do what so many of them desperately want to do - work and live independent lives.
The program succeeded above all because health care coverage under both Medicaid and Medicare was imaginatively grafted onto job-training and job search assistance. The main author, as usual, was Kennedy. President Clinton and Gore were aboard early and vocally, and a legislative effort that began as reasonably bipartisan eventually became a congressional tidal wave of near-unanimity.
The expansion is a carefully constructed program of incentives and services aimed at one of the major obstacles to work - the near impossibility of obtaining health insurance. It works because it assembles a considerable array of building blocks under existing laws, adds to them with a new law, and utterly changes the landscape for the half of all disabled people who are covered under Medicaid.
And Bradley's astonishingly poorly conceived health care proposals would aim a dagger at it.
Indeed, outside of a few attempted reassurances with no details, for Bradley the disabled don't exist at all. Instead - along with all kinds of extremely vulnerable people - they would be tossed into ''special needs'' or assigned risk pools for insurance coverage of unknown dimensions, unknown costs, with unknown strings, copayments, and deductibles.
In jettisoning Medicaid for insurance premium subsidies that don't come close to matching the program's careful mix of benefits and services for those who need health care the most, Bradley goofed big time. He could repair the goof, but that would require a huge increase in the costs associated with his health care ideas, and so he does nothing.
As it turns out, the guy with the big idea in this fight, the leader able to bring about change on a huge scale and with a detailed track record of helping the Clinton administration do it time and time again is Gore.
Bradley's contemptuous dismissal of Senator Kennedy last week was a crude attempt to mask an important fact of life - not a political one, but a substantive one.
The country's most important advocate and workhorse for national health insurance is also the country's most imporant advocate and workhorse on the building blocks in health care that can make universal coverage happen.
And this guy who has been doing the hard work for only about 30 years longer than Bradley is backing Al Gore for president for reasons that have everything to do with that work.
Politics doesn't help much on this. Getting involved in presidential primaries (1980 notwithstanding) is a famous Kennedy no-no, above all in years he is running for reelection.
Breaking long precedent required what pure politics couldn't supply, but the Kennedy-Clinton-Gore record on health care can.
As Kennedy put it, they have conspired on a number of big casino matters: making health insurance portable for workers, putting huge new investments into the disease-fighting operations of the National Institutes of Health, the protection and expansion of Medicaid and Medicare, the enactment of an effort to insure half the country's 11 million uninsured children, and now the most important assault on the problems of the disabled in years.
In supporting Gore, the senator who put universal health coverage on the nation's agenda almost 30 years ago and has never let it be removed remarked that piling up these building blocks is ''the best opportunity to get to universal coverage.''
Not surprisingly, Gore himself made the same point in the debate at the University of New Hampshire Thursday night.
Bradley's snide swipe at Kennedy as ''the establishment'' and his above-it-all view of policy-making life in Washington's ''bunkers'' betray his own disdain for the hard work it takes to make things happen against the determined oppposition of special-interest lobbies that have fought decent health care ideas throughout this century.
As always, his fingernails are too clean.
Having done the work, Gore knows that Medicaid is not just a poverty program; it is a safety net. It doesn't just provide insurance, but for the disabled it also provides services like rehab care and transportation that are just as vital. When people on Medicaid got jobs under previous law, there was often a literal choice between working and keeping health care.
Under the legislation Kennedy (and Vermont's GOP senator, Jim Jeffords) passed with the administration's support, there would be revolutionary change.
And Bradley's grand idea is to put it all at risk.
Thomas Oliphant is a Globe columnist.
