The hero of health care

Bruce L. Bortz

April 22, 1993|By Bruce L. Bortz

Some call him the hero of the just concluded 1993 legislative session. Others find such accolades offensive. Whichever side of the health care argument they're on, however, everyone agrees that Del. Casper Taylor (D-Allegany, Washington), the chairman of the House Economic Matters Committee, was the session's central player.

Through hard work, bull-dog determination, the help of influential friends, and a series of master political strokes, Mr. Taylor shepherded to passage one of the most important bills enacted in many years -- a measure whose far-reaching nature sneaked up on practically everyone in the session's final weeks.

Against considerable odds and without the benefit of an active, identifiable or sympathetic constituency, Mr. Taylor managed to pull off the session's pre-eminent accomplishment. Not the sort of thing you'd expect from a balding, bespectacled, shortish man of nearly 60 with the unprepossessing look of an accountant.

Mr. Taylor's bill does two things. First, it requires health insurance companies to offer employees of small businesses modestly-priced, plain-vanilla coverage. Small business owners aren't required to pay for policies. But they eventually may be forced to by employees aware of the legislation and the less expensive policies it spawned.

The bill's wild card, though, is its second main feature -- a commission to gather information on what doctors and other health professionals charge patients. Under its statutory authority, the commission can later use this data to regulate doctors' fees -- much as the state's Health Cost Services Review Commission has long done successfully with hospital charges.

A legislature loath to create new bureaucracies has shown unusual commitment to this one. Its initial $5 million annual budget is a strong signal to the medical community that "we mean business."

The medical community contributed big bucks to legislators running in the 1990 elections. Mr. Taylor himself took in nearly a sixth of his PAC (political action committee) money from medical and health interests. But on health care reform in '93, these so-called special interests didn't get much of a return on investment. If the bill works as Mr. Taylor hopes, it'll change the way we buy health insurance and bring the bills our doctors and other health professionals send us under control.

How did Mr. Taylor pull off such a legislative miracle? First, this self-described consensus builder managed to win the hearts and minds of key power brokers. Gov. William Donald Schaefer, through health secretary Nelson Sabatini, helped by lobbying key legislators.

Mr. Taylor's biggest assist, though, came from House Speaker Clayton Mitchell, who got Del. Ronald A. Guns (D-Cecil), chairman of the House Environmental Matters Committee, to defer to Mr. Taylor's committee.

In past years, medical interests were able to play the two committees off against each another and nothing much was accomplished. This year, the Speaker seemingly decided to overshadow the John Arnick confirmation fiasco. The session would have to produce something big, and that meant giving one committee overall authority.

Mr. Taylor also used stealth. The fee-regulating commission came into being through a late-arriving amendment, which was approved after relatively brief discussion in his committee. Immediately after the vote, some committee members weren't even sure what they had voted on.

Mr. Taylor also took advantage of a unique opportunity. State doctors traded in their chief lobbyist this year for Marvin Mandel. The former governor wasn't up to speed on the issues, didn't know the members well, and allowed his client to get caught -- big-time -- in the switches.

Some of Mr. Taylor's triumph is also traceable to his leadership style. He has spent all 19 years of his legislative career on the House Economic Matters Committee. For eight years, he served as the vice-chairman; for the last seven, he's been chairman. It is his committee. Most often, though, he has run the show like a referee balancing competing interests, letting people have their say on their bills and endearing himself to fellow committee members with his even-handedness.

Mostly, though, Mr. Taylor got health reform through this year because of persistence. In 1990, he said publicly he wanted to create a mechanism to review and keep down medical costs. Two years later, he insisted Maryland should conduct such an experiment so that federal health care reformists could decide if it was the right direction for the nation to take. But he couldn't get his Senate counterpart, Finance Committee Chairman Thomas O'Reilly (D-Prince George's), to go along on the details.

A year ago, having paid for the college education of his two daughters, Mr. Taylor sold off his tavern interests and used the extra time to campaign quietly but ceaselessly for his health care reform proposals.

In 1986, Mr. Taylor wanted very much to be House Speaker. But he saw the cards stacked in favor of Mr. Mitchell, and he made the best deal he could -- support for Mr. Mitchell in return for the Economic Matters chairmanship. The give-and-take made him the first Western Maryland delegate to chair a major House committee in modern times. In a post-Mitchell era, the votes for Speaker could well go in favor of this session's consummate politician.

Bruce L. Bortz is editor of the Maryland Report newsletter. He writes on Maryland politics every other Thursday.

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