WASHINGTON — Sen. Max Baucus, D-Mont, had digested all the dry statistics and the policy papers about America’s hobbled health care system by the time he arrived at a town hall meeting in Havre last October.
For the next hour and a half, the senator sat rapt as he heard about it in personal terms: parents of a son injured in a car accident who struggled for years to find affordable rehabilitation; a local Vietnam War vet who had to travel to Portland, Ore., for a kidney transplant and continued to endure the runaround for health care; a hospital executive who said the relatively high percentage of patients who can’t pay their full bill is forcing higher rates on those who can.
"It really hit me at that hearing," Baucus said recently as he sat in his Capitol Hill office. "So many people were distraught. They couldn’t get health insurance because of pre-existing conditions or it was way too expensive, and they couldn’t pay for something that was basic. … Boy, that got my attention. You can see it in people’s eyes."
As a primary engineer behind health care reform, the Montanan draws on those stories to advance what he hopes will be a monumental restructuring of medicine in the United States, where nearly one in four Americans is underinsured or has no coverage at all.
Baucus chairs the Senate Finance Committee, which has begun holding hearings and discussions on what the plan should look like. The panel is responsible for the oversight of public health funding, which would have to be increased to pay for expanded coverage.
In addition, it will be tougher to get health care legislation through the closely divided Senate than the House, making Baucus’ role that much more important, said Ron Pollack, executive director of Families USA, which is pushing for universal health care.
"Senator Baucus is probably the person who is going to make the biggest difference on the achievement of health care reform than any person in the Congress," Pollack said. "He is truly in a pivotal position, and so far he has performed remarkably."
President Barack Obama is urging Congress to pass a health care bill by December. Baucus aims to deliver, saying if it doesn’t happen this year, the rancorous politics of congressional and presidential elections will make sure it won’t happen for six to eight years.
Baucus calls health care expansion "a moral and economic imperative," but said he’s not wedded to any particular approach or any specific way to pay for it, though he believes it must be funded by both private and public sources.
"Basically, I’d like to see a system in America where everyone knows that he or she (has) quality health insurance and will get quality care, and costs are manageable," he said.
The stakes are high for his home state, where long distances between population centers can make it harder to get care. Baucus said comprehensive health care reform could mean lower insurance costs for Montana families and new programs, such as computerized health services, that would be useful for rural America.
Baucus has been thrust into a key health policy role, in part, by circumstances.
Hillary Rodham Clinton, who led unsuccessful health care reform efforts during her husband’s administration, is now secretary of state and consumed with world affairs. Former Senate Majority Leader Tom Daschle, D-S.D., had been tapped by Obama to lead efforts as Health and Human Services secretary until tax problems forced his withdrawal. And Sen. Ted Kennedy, D-Mass., who chairs the Senate Health Panel, has been slowed by brain cancer.
All of which has put Baucus, 67, and his committee, largely in charge of steering a plan through Congress.
"I’m not in charge," Baucus said with a laugh. "There’s nobody in charge. This is the Congress."
Baucus is keenly aware of how health care reform failed in 1993, and doesn’t want a repeat.
"We’ve learned lessons from ’93. The (Clinton) administration gave this 1,600-page bill to Congress and said: ‘Here it is — pass it’," Baucus said. "Obama, on the other hand, said: ‘Hey Congress, here are some principles. You do it and make it better because you’ll give us more buy-in and expose it to more people around the country, so we’re less likely to make mistakes."’
Baucus’ decades-long friendship with Sen. Chuck Grassley of Iowa, the top Republican on the Finance Committee, will come in handy as he tries to forge a bipartisan bill. It has to be bipartisan, Baucus said, or else it won’t have the national support it needs.
Not everyone thinks the process has been inclusive so far.
"If you’re asking do I think bipartisanship is a laudable goal, the answer is yes," said former Utah Gov. Mike Leavitt, a Republican who served as Health and Human Services secretary under President George W. Bush. "Am I suggesting what we’re seeing is a clear bipartisan approach to the problem? I would say no."
Baucus also has been dinged by the group Consumer Watchdog, which earlier this year scolded the senator for accepting $183,750 in campaign donations from health insurance companies and $229,020 from drug companies — the most any congressional Democrat received during the past two election cycles.
The senator said he doesn’t pay attention to those criticisms, and quickly points out that he also is trying to curb payments to health maintenance organizations.
"They don’t like me" he said of HMOs.
Baucus doesn’t have much time to listen to critics. He must deal with a multitude of health care stakeholders — doctors, unions, consumers, insurers, drug companies and other members of Congress — trying to make sure that what began 16 years ago gets done this time. He’s sure it will.
"The problems are much greater now than they were in ’93. The costs are much higher. The demand for change is much greater," Baucus said. "The stars just seem to be aligned."