Will This Man Fix American Health Care?

It started with a rocket ship (which is something we health care reporters rarely get to write). Monday morning, in the Mumford Room of the James Madison Memorial Building, Sen. Max Baucus, D-Mont., grinned broadly as the projector behind him showed the Apollo 11 blasting into space. "I think that video captures the essence of what we're trying to do today," said Baucus proudly, "which is prepare for the launch of health reform."

Whether anyone is actually more prepared today than they were two days ago is debatable. The various sessions of the Senate Finance Committee's "Prepare for Launch" Health Summit were informative enough but offered nothing the senators hadn't heard in previous testimony or read in memos from staff. No legislation was proposed, and no votes were taken. None of the senators set forth their reform plans or laid out the considerations that would drive their decisions.

Even so, it was arguably the most promising day for health reformers in a decade. The Finance Committee asserted its jurisdiction over crafting and passing a health reform bill. And Baucus, the committee's centrist chair, asserted his commitment to the effort. If health reform is to pass, both of those things will need to be more than assertions; they will need to be proven true.

The choke point for health care reform is the U.S. Senate, where major legislation tends to require 60 votes for passage. Getting 60 senators to agree on breakfast or wallpaper swatches would be a challenge. Getting them to agree on restructuring America's health care system is more a cosmic test conceived by the Gods of Gridlock.

But before any bill can get to the Senate at large, it must first be written. Legislatively, there are arguably three institutions that could shoulder the bulk of that task. The first is the executive branch. In 1994, the Clinton administration tried this tactic, attempting to bypass Congress almost entirely and simply present it with a near-final bill for ratification. In retrospect, this is considered by most to have been a terrible error, one of the crucial mistakes of the 1994 effort (for a longer explanation of why, see this article). The second is the Senate Committee for Health, Education, Labor, and Pensions. Led by Ted Kennedy, the HELP Committee is decidedly liberal and wants nothing more than to be given health reform and told to run with it. Members could pass an expansive, progressive bill out of committee with relative ease. The problem is, they lack the authority to fund such a bill.

Principal jurisdiction lies with the Finance Committee, as the rules of the Senate give it control over "health programs under the Social Security Act and health programs financed by a specific tax or trust fund." In other words, health care reform plans that require revenues require the Finance Committee's involvement. And health care reform will require revenues.

So health care reform requires a Finance Committee -- and a Finance Committee chairman -- interested and invested in passing a bill. In 1993, there was no such chairman. Many think that the original sin of the Clinton health reform effort was Clinton's decision to choose Lloyd Bentsen, the canny chair of the Finance Committee, as his secretary of the Treasury, thus depriving the committee of his leadership. In his place came the mercurial, touchy Daniel Patrick Moynihan. Moynihan had many virtues, but he did not like the Clintons and was not interested in working on health reform. His intransigence and general lack of enthusiasm were crucial to emboldening the opposition and killing the bill. When Moynihan appeared on "Meet the Press" on Sept. 19, 1993, three days before Clinton was to give his speech calling for universal health care, and flatly stated that "there is no health care crisis" and Clinton was using "fantasy numbers," it was an early sign that the effort was doomed.