Baucus has been the most public about developing a bill — and the fastest mover.

The House committees involved have met in secret and are only in the very early stages of writing the legislation — a meeting by Energy and Commerce Democrats on May 13 was the first one, even though Baucus has been bringing his committee members together for months now.

Baucus has been helped by less fortunate events as well. Kennedy’s HELP Committee has been meeting with industry and lobby groups for some time, and Kennedy was expected to take the Senate lead on health care given his reputation as a deal maker, his close relationship with President Obama and his long interest in the issue. Since his brain cancer was diagnosed last year, however, he has been largely away from the Senate. He regularly speaks with colleagues by phone, but his absence has left Baucus as the main driver.

“If you think of it as a marathon, he came out quickly and is going to be crossing the finish line ahead,” said Nancy LeaMond, one of the top lobbyists for the AARP, an organization serving people age 50 and older.

Then there was former Senate Majority Leader Tom Daschle, D-S.D. (1987-2005), Obama’s pick to spearhead the White House Office of Health Reform and head the Department of Health and Human Services. His high profile and mastery of the Senate made it seem like Daschle would be the man to guide the process. But then came the revelations — during vetting by the Finance Committee — that Daschle had paid more than $140,000 in back taxes and interest, and he withdrew.

“Daschle’s implosion ... forced somebody to take up the mantle and make it happen,” said Len Nichols, director of the centrist New America Foundation’s health policy program.

With the House largely staying silent on the issue, the field was clear for Baucus.

Baucus has been a player before in major health care debates — the 2003 Medicare law being the biggest — but he had never mapped out a comprehensive health care vision, such as expanding Medicare to everyone, as Stark has proposed. Instead, he has written his health care vision largely from scratch over the last several years.

“A couple of years ago, he began to know that health care reform was going to be a very big issue, and he was going to have an opportunity to lead,” LeaMond said.

In February 2008, when the Democratic presidential candidates were just beginning their long-running primary fight, Baucus was already appearing before interest groups to talk about his developing plans. He spoke to the AARP’s board of directors about writing a full-scale overhaul of the system at a time when many inside the Beltway were still stuck on the idea of incremental change.

At the session, he called for the “shared responsibility” of employers and workers to pay for part of the cost of expanding coverage, and he spoke about the fiscal unsustainability of rising costs, not just for Medicare and Medicaid, but for America as a whole. Unlike many liberal Democrats before, he made health care a financial issue, not a moral one.

February 2008 was also when Baucus rehired longtime aide Liz Fowler to be senior counsel. Fowler had gone to the private sector and now heads Baucus’ overhaul efforts. According to lobbyists who watch the committee closely, Fowler is the brains of the operation and responsible for putting together many of the policy proposals. “We saw that as a sign that he was very serious,” LeaMond said.

In May 2008, Baucus began hearings on an overhaul, holding nine sessions focused on what would become, a year later, some of the most controversial issues in writing a bill, such as changing the tax code and reshaping the insurance market.

By the end of the presidential campaign, when the economy was collapsing, voters were thinking about health care in terms of their pocketbooks, and Obama and others were portraying an overhaul as an economic issue. But Baucus had been some months ahead of them. “What really signaled the sea changes was [that] summer,” Nichols said. At a June 16 session held at the Library of Congress, Baucus brought in Federal Reserve Chairman Ben S. Bernanke as his keynote speaker.

“Health care is not only a scientific and social issue; it is an economic issue as well,” Bernanke told the assembled audience of lawmakers, aides and heads of industry. “The decisions we make about health care reform will affect many aspects of our economy, including the pace of economic growth, wages and living standards, and government budgets.”

“The momentum he engendered by thinking about it as an economic question catapulted it to where he could compete with Waxman and Stark,” Nichols said. “It’s not that we can’t afford this, we can’t afford not to — that language came from him.”

Filling in the Blanks

But a thousand good policies have died quiet deaths in Washington. Politics moves legislation, not good intentions. And on that front, either by intent or luck, Baucus has created a timetable for dealing with the issue that favors his chances.

Right now, most of the attention is being paid to whether to include a government-run insurance option. If one is included, Republicans and private health insurers have promised to torpedo the bill. The “public option” has become the dominating issue in the debate, and Baucus has done almost nothing to tamp down the speculation — only reiterating that “everything is on the table,” again and again.

But some see it as little more than a strategic distraction. “There’s going to be no public plan,” Laszewski said. “It’s a bargaining chip.” What the proposal has done, however, is scare the insurance industry into coming to the table and making major concessions. In the end, the public plan option appears to be turning into a watered-down version that will not have significant impact on the market.

The public plan proposal has, however, held the attention of Washington while Baucus, Finance ranking Republican Charles E. Grassley of Iowa and others quietly work out far knottier issues, such as whether to create a mandate for people to buy insurance or whether to put a cap on the tax exclusion for employer-provided health care benefits.

The Finance and HELP committees, along with the House, are headed toward markups in June, with floor action in July. “It was Sen. Baucus who came up with the schedule, and did so with Sen. Grassley,” said Ron Pollack, executive director of consumer advocacy group Families USA.

Initially, Baucus had planned to release a health care bill in January. But he backed off, opting to sit on his bill while he worked with members and held hearings. Then, at a March 1 meeting, according to an aide to Baucus, he and Grassley decided on the summer timeline.

“Originally Kennedy had wanted to introduce a joint bill at or around the time of inauguration. Over time, I think it was felt that was not the smartest thing to do and it really required more processing,” Pollack said.

“The thing you have to give them credit for, and Baucus if he’s the one that did it, is the condensing of the length of the debate,” said Robert Blendon, a professor of health policy and political analysis at Harvard University. At the same time that Congress has been working through far more complex issues than the public plan, lawmakers and industry leaders have avoided hashing them out in public, where ad campaigns, news releases and hard lines by lobby groups could all derail the process.

“That strategic decision will change the nature of the debate,” Blendon added. And if Baucus does come out with a bill that causes health industry groups to go to war against the bill, it may be far too late. “The ability of groups to mobilize against it across the country will be much shortened,” Blendon said. “August is a tough time to get the public riled up about something.”

It is still too early to judge Baucus’ prospects for success. This month, he will have to write his bill and pick winners and losers — the “blank slate” period will be over.

“My experiences with him, especially in private, are that he has clear and strong views, but he also is a consummate person in trying to get to ‘yes’ with people,” Pollack said. “Publicly, he tries to make clear that he’s open to a variety of approaches.”

At some point, he will have to say no — both to the industry groups trying to keep their piece of the pie and to members on both sides of the aisle who want something he does not think Congress can deliver.

“We’re in the first three miles of the marathon,” Jonas said. “We will get to the end of this and Max Baucus was perfect for the role because he was so flexible.”