WASHINGTON DC — Two hours into a recent Finance Committee hearing, every other senator had wandered off, but Chairman Max Baucus was serving notice that he would find a way to make healthcare overhaul possible, even with an economy spinning out of control – and that he needed help.

The head of the Congressional Budget Office, Douglas Elmendorf, was being too cautious for Baucus’s taste about how much money could be saved through strategies like disease prevention and computerizing medical records. Baucus urged him to be honest, but more creative: The budget office, he said, would "make or break healthcare reform, because we need to go by your numbers." Elmendorf disagreed: The hard decisions, he countered, would be the Senate’s.

"No, that’s incorrect," Baucus said. "The hard decisions will be all of ours – both of us, you and me. You can’t pass the buck… The hard decisions are all of ours in the country who are trying to make this work. Hearing’s adjourned."

That Baucus himself isn’t passing the buck on healthcare reform has been the most encouraging sign in a tumultuous year for advocates of universal healthcare. The careful Montanan, known for irritating the left wing of his party by compromising with the GOP on a range of matters, including the 2003 Medicare prescription drug bill, has suddenly become a leading force behind legislation that liberal Democrats have longed to pass for the last half-century.

At a time many see as the best opportunity in 15 years for a comprehensive healthcare overhaul, Baucus, 67, has stepped into an unexpected leadership void. Senator Edward M. Kennedy, a leader on the issue for decades, is suffering from brain cancer. Obama’s initial point-person on health reform, Tom Daschle, who boasted both extensive legislative experience and in-depth understanding of the policy, withdrew his nomination for Health and Human Services secretary because of tax problems.

Because of Baucus’s tendency to hew to the political middle, many healthcare reform advocates feared that the Democrats’ top voice on finance would decide that a health bill was too expensive amid an economic crisis. In 1993, Finance Committee Chairman Daniel Patrick Moynihan insisted that healthcare reform wasn’t a priority and helped kill Bill Clinton’s plan.

Baucus has chosen a starkly different course, arguing with evangelical zeal that the economy’s free fall is not an excuse to put off changes in healthcare but rather a compelling reason for a comprehensive fix: Healthcare costs, he argues, are bankrupting individuals, businesses, and government.

And he moved quickly early on to establish his credibility on this thorniest of issues. Since last June, he has held hearings, hired top policy staff and issued a widely praised 89-page blueprint for reform days after the election. His conviction has startled and impressed healthcare advocates.

Moynihan "did everything he could to move the subject away from healthcare reform he clearly was not a partner," said Ron Pollack, president of Families USA and a veteran of the Clinton healthcare debate. "Senator Baucus is the exact opposite, so it’s really a breath of fresh air."

With growing prominence, Baucus has also faced heightened scrutiny; the Consumer Watchdog group listed him as the top Democratic recipient of contributions from insurers and drug companies, though he has defied both industries on a litany of issues over the years, including in his reform blueprint.

"For 30 years, Max Baucus has only been influenced by one thing: What’s right for Montana, and what is right for the nation," said a Baucus spokesperson. "Healthcare reform is the same."

Though there was initially talk of a turf battle between Baucus and Kennedy, the two senators have been working closely and their proposals, at least so far, appear to be aligned. "Ted’s the best legislator of modern times," Baucus said. "Seeing his passion and how effective he’s been over the years is something that has meant a lot to me."

Baucus’s embrace of the healthcare issue indicates the extent to which attitudes about healthcare have changed since 1993-94, when Clinton attempted an overhaul. Then, the small-business lobby saw Baucus, the second-ranking Democrat on Finance, as an easy target and went after small-business owners in Montana, stoking their fears that the Clinton plan would force them to buy expensive healthcare plans for their workers. Baucus voted against an employer mandate.

The small-business lobby still sees an employer mandate as anathema, but its members are now clamoring for the government to take action of some kind, as are businesses and voters nationwide. Milt Datsopoulos, a longtime Montana friend, says Baucus has monitored the situation with increasing concern.

"He meets with people like single mothers who have two or three little kids, the father walked out on them, and their biggest agony is they have sick kids and they can’t get to the doctor," he said. "I think it’s become a very personal issue with him, as well as a political commitment."

Baucus, with his slim frame and unassuming air, does not come across as a Washington powerbroker. His voice can be so quiet and halting that it can sound as if it is on a distant AM radio station, flickering in and out. He is rarely a guest on the Sunday morning political shows, and outside of politics, he likes solo pursuits, like reading and running (he has competed in 50-mile races).

"Max could put times under six minutes on a mile in the 1990s," said former senator Bob Kerrey, who used to run with Baucus when he was in the Senate.

Baucus grew up on his parents’ sheep ranch, one of the state’s largest, outside Helena, and friends say the landscape and sensibility of the place and its people formed him.

"You see farther than the eye is used to going," said Mike Miles, a childhood friend. "Friendship, and learning to live with neighbors, was very important, as well as a sense of individualism."

As a youth, though, Baucus ventured far from home, attending college and law school at Stanford and traveling the world for a year. Back in Montana, he rose quickly in politics, winning election to the House in 1974 and to the Senate in 1978. His longtime chief of staff, Jim Messina, now deputy chief of staff to President Obama, said Baucus is a gifted campaigner because he strikes voters as genuine, even if he never gives a stemwinder: "He seems just like a guy they know at the bowling alley," he said.

Baucus has served on Finance since he was a freshman, and he and Senator Charles Grassley, a Republican, have traded the chairman’s seat since 2001. Grassley, a gruff, self-assured Iowan, is Baucus’s closest ally in the Senate. Together they co-authored the 2001 Bush tax cuts, and they have rarely produced legislation that is not bipartisan – a source of pride for both, and sometimes of frustration for Democratic leaders.

They meet weekly; their staffs work in tandem, running the Finance Committee "like a mom and pop shop, and the proprietors are Max and Chuck," said Ross Baker, a political scientist at Rutgers University.

Auguring the difficulty of the task ahead, Grassley has already tested Baucus on healthcare, signing onto Senate minority leader Mitch McConnell’s letter to the president saying that he would not consider a Medicare-style public insurance option, something Obama campaigned for and Kennedy and Baucus strongly support.

Yet Baucus has set his sights high, hoping to win the support of 75 of the 100 senators. In an interview in his office the other day, his eyes were red and his face deeply creased. It is, he said, the hardest thing he has ever tried to do.

"This establishes a new meaning for masochism," he said with a laugh, "but I love it, I relish it."