We won’t know for months whether an attempt at major health care reform will come to fruition next year. But the massive undertaking already is starting out better than a similar effort in 1993-94.

At that time, we also had a newly elected president and substantial Democratic majorities in the House and Senate. But even the best-laid plans of then-first lady Hillary Rodham Clinton for universal coverage ran into trouble from the start. The key problem was that she conducted much of the work of her health care commission behind closed doors.

The process this time around is transparent. It is being led by two titans of the Senate—Finance Committee Chairman Max Baucus, D-Montana, and Health, Education, Labor and Pensions Committee Chairman Edward Kennedy, D-Massachusetts.

On November 12, Baucus released an 89-page policy paper that outlined the areas that he believes must be addressed in comprehensive reform.

The paper was the product of several health care hearings—and an all-day event at the Library of Congress in June—that Baucus has headed.

On a different track, Kennedy has been leading wide-ranging discussions on health care reform for months with Capitol Hill colleagues and others with a stake in the issue. He likely will introduce his own bill. 

Just because Baucus and Kennedy are taking separate routes at the beginning doesn’t mean that they will wind up in conflicting places. On Wednesday, November 19, the Finance and Health, Education, Labor and Pensions committees held a joint meeting in which they agreed on a process for moving health care reform forward.

Baucus and Kennedy have pledged to follow “regular order.” That means there will be subcommittee and full committee hearings, committee votes on bills, Senate floor action and a conference committee to reconcile Senate and House measures.

This ensures that every voice in the health care reform cacophony will be heard. It also means that there will be plenty of opportunity for the effort to hit serious snags.

One of the first challenges will be a debate over how to pay for reform. In a statement prepared for a November 19 hearing, Sen. Charles Grassley, R-Iowa and ranking member of the Finance Committee, pointed out that the federal budget deficit is already at least $400 billion and heading much higher if you factor in the $700 billion financial markets bailout package.

He warned that the deficit could reach $1 trillion before health care reform is factored in. Paying for the changes that Baucus suggests—or agreeing not to pay for them initially—will require a heavy legislative lift.

“That issue is going to be an 800-pound gorilla in every negotiating process,” Grassley said after the Finance and Health, Education, Labor and Pensions leadership meeting on Wednesday.

Baucus argues that major health care reform cannot wait for the economy to improve and that Congress can’t get hung up on what are called “pay fors” in Capitol Hill parlance.

“There are going to be upfront investments that are necessary,” Baucus said. “We have to invest today to reap the rewards later.”

Baucus is passionate—more so than his low-key Mountain West personality can convey—about doing health care reform immediately when the next Congress convenes in January.

“Some say that we will have to choose between fixing the economy and enacting comprehensive reform health reform,” Baucus said in a statement. “I reject that false choice. Comprehensive health reform legislation must be part of any successful economic recovery plan.”

The chairman is off to a good start. He has Republicans and Democrats talking about achieving consensus. It looks as if he’s serious about listening to everyone, including the budget hawks.