Two numbers are becoming important as Congress formally begins the process of hammering out health care legislation this week: 80 and 20.

Many health care advocates say that about 80 percent of medical costs are generated by 20 percent of patients. On Capitol Hill, the ranking Republican of the Senate Health, Education, Labor and Pensions Committee, Mike Enzi, R-Wyoming, said his party and the Democrats agree on about 80 percent of health care reform.

But it’s the disagreement over the 20 percent of the remaining issues that is turning health care happy talk into grumbling. In a June 11 press conference, Senate HELP Committee Republicans accused Democrats of keeping them in the dark about the details and costs of the panel’s massive health care bill.

Indeed, the draft left out major items that will be added later, including an employer mandate and a government insurance coverage option.

Those omissions made it impossible for the Congressional Budget Office to do a complete analysis on the cost of the bill. Its preliminary projection is that the Kennedy measure would add $1 trillion to the federal deficit by 2019. In addition, the number of people covered by employers would decline by 10 percent, or 15 million.

Like Senate Republicans, the CBO said that it has not had a chance to parse the draft legislation, which the HELP Committee is slated to begin marking up on Wednesday, June 17.

“Although our reading of the draft language has informed our analysis, we have not had time to complete a thorough review of that of that language, which could have significant effects on any subsequent analysis provided by CBO and the JCT (Joint Committee on Taxation) staff,” the CBO stated.

The potential cost of the bill is giving Sen. Judd Gregg, R-New Hampshire, pause about the whole effort.

“So far, we haven’t seen any pay-fors,” Gregg said, using Capitol Hill lingo for provisions that would finance the package.

Gregg and his colleagues urged Democrats to slow down, even though President Barack Obama has told Congress to get a bill to his desk by this fall. That pace requires votes in the House and Senate by the end of July.

“We’re going more by deadlines rather than whether we’ve got it right or not, and that’s a mistake,” Enzi said.

Republicans also are digging in against the so-called public option in a national insurance exchange. They see such a government program as the single-payer camel’s nose poking into the health care tent.

Obama spoke for nearly an hour to the American Medical Association annual conference in Chicago on Monday, June 15, to try to allay fears about the cost of health care reform and the public insurance option.

He tried to pull off political jujitsu by portraying health care reform not as a budget buster but as the key to bringing down the current $1.8 trillion deficit. Failure to pass a bill this year would allow medical costs to spin out of control, he asserted.

“So to say it as plainly as I can, health care is the single most important thing we can do for America’s long-term fiscal health,” Obama said.

He says the administration has identified $950 billion in savings as a down payment on reform. He also says that he has commitments from hospitals, labor unions, insurers, medical device manufacturers and drug companies “to work together to cut national health care spending by $2 trillion over the next decade, relative to what it would have otherwise been.”

He touts a public insurance option as another way to cut costs because it would provide competition to the private sector.

In his AMA speech, he also pointed out areas where there is widespread agreement, such as computerizing health care records and investing in preventive care and research on the effectiveness of treatments. He made many of the same points highlighted by a group called America’s Agenda.

The big question hovering over Washington this summer will be whether Democrats and Republicans will coalesce around the policies that draw bipartisan support, or will they scuttle the whole health care effort over the 20 percent that stokes political anger.

There’s a chance that the process will go more smoothly in the Senate Finance Committee and that its bill will eventually be melded with the HELP bill into a measure that draws a strong Senate majority.

In fact, 80 is a good goal for the number of senators voting for final health care legislation. There are probably 20 Republicans who will never be convinced to support reform.

But if Democrats can’t persuade reasonable members of the GOP—like Enzi, Gregg and the top Finance Republican, Sen. Charles Grassley of Iowa—to vote for it, then the bill probably needs to be scaled back or scrapped.