Long ago, I heard Joseph Califano, President Carter's secretary of Health, Education, and Welfare (later to become Health and Human Services), tell an audience that real health care reform in this country could not become a reality until we accomplished the goal of enacting campaign finance reform at the national level.

A report issued last week by Consumer Watchdog, a California-based organization, reminded me of Califano's remarks. The report found that over the past four years the health care industry and drug companies have showered the top-ten recipients in Congress with $5.5 million in campaign contributions. Taken together, the health care sector has contributed just-under a whopping $1 billion in the past two years alone.

From my point of view, and from the point of view of most liberals familiar with the subject, real health care reform must include a "public" option - that is, one that competes with private insurance. A public option would mean that consumers and employers would have the choice of keeping their private insurance or moving into a public plan. During the presidential campaign, President Obama's health care blueprint included a public option.

Regrettably, it's becoming more problematic with each day that goes by that we will get that kind of choice in the final bill. The real problem is the Senate. Given the sizeable majority of Democrats in the House, it is likely that a public option will be included in the House version of the legislation. But the existence of the filibuster in the Senate is a serious roadblock to reform.

Not only will Senate Republican oppose public health insurance en masse, but several key moderate Democrats are likely to resist as well. First and foremost is Senator Max Baucus. With the illness of Ted Kennedy, Baucus will play a key role in crafting the legislation as chair of the Senate Finance Committee. The Senator from Montana raked in $413,000 over the past four years from drug companies and health insurance carriers.

Other key moderate Senate Democrats of concern are Mark Warner of Virginia, Robert Menendez of New Jersey, and Ben Nelson of Nebraska -- all of whom received significant amounts of campaign cash from these two special interests. Independent Joe Lieberman of Connecticut is also on their favorites list.

We are about to find out whether Mr. Califano got it right. If the past is any indication, he is. And though it's been said countless times before, it bears repeating: the United States stands alone among western democracies in its repeated failure to solve the pressing crisis in health care.

Can real reform be accomplished given this pessimistic assessment? Of course. Even some of those who opposed "Hillary care" in 1994 have changed their tune. This is especially true of large and small employers alike who are tired of paying the escalating cost of their workers' healthcare. But the real key is the public, which will have to wake up from its long slumber and demand it.