WASHINGTON - Ted Kennedy wakes up mornings in his house on Cape Cod to a packet of news clippings put together by his wife. If there's a hearing going on in Washington, D.C., he watches on his computer.

Five hundred miles away, Congress is wrestling with historic legislation to give every American access to quality health care. It is the moment the Massachusetts Democrat has worked toward for 46 years. But instead of marshaling the crowning achievement of his political career, he is sidelined, battling brain cancer.

"He has lived for this day when America would finally extend this right to every citizen. There's no doubt if he could, he would be here in the thick of this," Kennedy's son Patrick, a Democratic congressman from Rhode Island, said in a recent interview, sitting on a bench on the Capitol grounds with tears in his eyes.

But history's third longest-serving senator isn't out of the game yet. Exerting what influence he can from his sickbed, he advises his aides in Washington over the phone. He has made himself the poster child of what he calls "my life's cause," and is using his illness in a final press for universal health care.

Kennedy, 77, seems determined not to miss this. He has outlasted medical expectations since doctors diagnosed a malignant tumor in spring 2008, and is not above expending every last bit of his political capital to deliver the bill he will be most remembered for. Democratic leaders are making plans to bring him back to the Senate floor later this year in a wheelchair, a bed if necessary, to cast his vote for heath-care reform.

"I have enjoyed the best medical care money (and a good insurance policy) can buy. … Every American should be able to get the same treatment that U.S. senators are entitled to," Kennedy wrote in an unusually personal essay published in Newsweek last week, adding: "We're almost there."

He cited his sophisticated course of treatment - risky surgery at Duke University Medical Center to remove part of the tumor, proton-beam radiation at Massachusetts General Hospital and multiple rounds of chemotherapy - as a privilege of the rich.

"My wife, Vicki, and I have worried about many things, but not whether we could afford my care and treatment."

Kennedy's aggressive cancer is bringing a sense of urgency to a famously slow-moving Congress, with friends on both sides of the aisle mindful of passing a bill in time for him to see it signed.

The last time he came to the Capitol was April. In June, he missed passage of his own ground-breaking measure to regulate tobacco. This month, Kennedy, who heads the Senate Health committee, could not participate in the crucial drafting of his legislation.

People close to him say he has his good days and bad. Sen. Christopher Dodd, D-Conn., who has taken over duties as chairman, has had dinner with him twice. Former aides recalled hundreds of meals at Kennedy's home in McLean, Va., or later on in Washington's elegant Kalorama, where experts on all manner of subjects gathered for lively exchanges that began in his study, moved to the dining room and finished in the living room, sometimes with Kennedy offering coffee. "Cream or milk?"

His well-informed staff is respected on Capitol Hill and in Kennedy's absence enjoys unusually direct access to some lawmakers.

"One of the things Teddy has going for him is the remarkable caliber of staff. Arguably they may be one of the best, if not the best, staff on the Hill. The staff's professionalism and reputation and credibility also go a long way to helping fill the void," said Tom Daschle, the former Senate majority leader and an informal adviser to the White House on health-care issues.

But Kennedy's aides, who have fiercely defended their boss' bill, have not been in a position to broker compromises and have caused tension at times, trying to carry on in Kennedy's stead while lacking his stature.

Few senators possess the friendships that have brought Republicans to the table or the gravitas that holds the party rank and file in line.

"He's the only Democrat who really has the sway with the unions, the trial lawyers, gays and lesbians, environmentalists, feminists," said Sen. Orrin Hatch of Utah, a conservative Republican who has teamed with Kennedy on health-care legislation for three decades. "We've linked arms on a lot of things for the good of the country. And I give him a lot of credit because it hasn't always been easy to link arms with me."

The tragedies Kennedy experienced in his life - his brothers' deaths, his son Ted Jr.'s partial leg amputation from bone cancer, his daughter Kara's lung cancer - shaped a commitment to universal health care that spans nearly a half-century.

Patrick Kennedy recalled traveling with his father in the 1970s to some of the poorest corners of America to highlight people without health insurance. He said his father walked the halls while hospitalized for treatment in Massachusetts and North Carolina this year, asking other cancer patients and their families how they were managing the bills. "It still breaks his heart," the younger Kennedy said.

Ted Kennedy's record on health-care reform is hardly flawless. Critics say his refusal to compromise with presidents Richard M. Nixon and Jimmy Carter missed promising windows of opportunity. During the Ronald Reagan years, he bowed to labor unions and declined to back a plan for catastrophic health insurance, a move he later regretted.

Now an overhaul seems more possible than it has in years, and Kennedy's absence is keenly felt on both sides.

Hatch hasn't heard from his old friend in more than a month. That's a long way from the days when, in the throes of creating a government health insurance program for poor children, Kennedy enlisted his chief of staff to serenade Hatch, an amateur songwriter, with one of his most patriotic tunes.

Back then, when Kennedy displayed his liberal stubbornness, Hatch would threaten to call his big sister, Eunice. "He'd say, 'Oh, no, don't do that. We'll work it out,' " Hatch chuckled at the memory recently. Last week, a frustrated Hatch walked out of bipartisan negotiations.

Such deep, cross-party friendships - it was Hatch who urged Kennedy to quit drinking after a fatal accident on Chappaquiddick Island in Edgartown, Mass., in 1969 - are rare today among younger lawmakers more focused on conquest than compromise. And, some people say, that's what's missing as opponents struggle to find common cause on an issue of great concern to most Americans.

Sen. Mike Enzi of Wyoming, ranking Republican on Kennedy's health committee, found himself largely left out of the process and took to calling the product the "Kennedy staff bill," refusing to believe his friend would have denied him a seat at the table.

"He wouldn't have done that," Enzi said recently. "I have always been able to sit down and have some input."

Some wondered privately if Kennedy could have headed off some of the contentious debates and staggering number of amendments his health committee's bill carried.

Patrick Kennedy said he believes his father is wielding a higher influence off the Senate playing field.

"He is a spiritual man. He prays a lot," Patrick Kennedy said. "And I think there is almost something spiritual about where he is right now. He is reminding every one of his colleagues about the fragility and the dignity of life. I feel like he's contributing in way that's perhaps more profound."

Times staff writer Mark Z. Barabak contributed to this story.

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