WASHINGTON -- The election of Bill Clinton has propelled Maryland Rep. Benjamin L. Cardin into the front line of debate over health care reform, an issue on which he is well-positioned and eager to play a role.
For the past two years the Baltimore Democrat pushed a bill to control costs and guarantee universal medical coverage, only to see it ignored in a government in gridlock led by a hostile Republican president.
But now Mr. Cardin, a member of the powerful House Ways and Means Committee and its subcommittee on health, finds himself working with a Democratic administration determined to reform the nation's health care system.
Suddenly, his immersion in a subject as complex as molecular biology is promising an already influential lawmaker greater prominence in the House and at home.
On Tuesday, Mr. Cardin will join a group of key House Democrats meeting with Hillary Rodham Clinton, who heads the president's task force on health care reform.
He's as optimistic about passage of legislation as others are gloomy.
"When I come back here next year we're going to be able to talk about the new health care system in this country," the 49-year-old lawmaker told an audience of senior citizens in Pikesville recently. "[You're] not going to be able to say, 'Why isn't anything getting done?' We're going to deliver for you."
Despite his confidence, he runs the risk of voter backlash if the reform effort stalls. But Mr. Cardin, a former speaker of the Maryland House of Delegates who is often mentioned as a potential candidate for governor next year, will see his stock rise if effective legislation passes.
Last year Mr. Cardin came up with a plan that would require employers to cover all workers and the government to cover everyone else.
Coverage of the 35 million Americans now without medical benefits would be phased in over five years -- without a tax increase and without exorbitantly raising the insurance costs paid by employers, he says.
He insists that the government and employers could absorb the costs of universal coverage because the expense would be more than offset by $200 billion in savings he says would result from cost controls at the heart of his bill.
First, he would set an annual national health care budget, a spending limit, apportioned among the states. Then he would require states to devise ways of meeting their individual budgets, or risk federal intervention.
Though he would give each state freedom to experiment, Mr. Cardin is using his bill to champion Maryland's system of controlling hospital costs as a potential national model.
In Maryland, hospital rates are set by an independent state agency. A key feature is that all bill payers -- the more than 1,500 insurance companies, Medicare and Medicaid -- pay the same amount to a hospital for service.
This so-called "all payer" provision has helped rationalize what were once wildly different methods used by hospitals to calculate charges.
It also puts Medicaid and Medicare patients on an equal footing with privately insured patients who have been more welcome at hospitals because they paid more through their insurance policies than the government paid under its programs.
"You shouldn't be getting a lower level of care because you are a Medicaid person instead of a Blue Cross-Blue Shield person," he says, explaining that the "all-payer" rate-setting concept could be extended to physicians and other health practitioners.
Mr. Cardin's bill, which he plans to reintroduce soon, places him in the thick of the health care debate. He is in tune with Mr. Clinton's goal of guaranteeing universal coverage, and with the president's stated interest in some kind of national spending limit.
Despite his fondness for Maryland's rate-setting system, Mr. Cardin says there's also room at the state level for what is called "managed competition," under which large groups of consumers and employers would negotiate with insurance companies and health care providers.
Where he differs with advocates of this market-based approach is in his belief that it's not sufficient to control costs.
"Every other industrialized nation in the world" controls costs either through some form of the Maryland system or the Canadian system in which the government pays all medical bills using tax funds, he says.
By allying himself with proponents of more stringent regulation, Mr. Cardin crosses swords with some of the industry groups that have sought to woo him -- and other lawmakers on congressional health panels -- with campaign contributions.
In his last election campaign, Mr. Cardin received nearly $10,000 from one of the two biggest contributors to congressional
campaigns, the American Medical Association, and at least $1,000 from each of 17 other health and insurance groups.
Dr. Daniel H. Johnson Jr., a member of the AMA's policy-setting organization, disdains national health budgets as a "euphemism for price controls," which he believes don't work -- and which would limit doctors' income.