Health Marathon: An Inside Look At How Congress Is Deciding Your Care

The third and last House committee considering health reform was entering the endgame, or so its members hoped, and chairman Henry Waxman (D-Calif.) opened by sharing some advice he gave a congressman before Thursday's work session. "I told him not to make any appointments before 1 a.m. Friday morning," Waxman said.

That's about par for the course these days. Asked how much sleep he's getting, Indiana Rep. Baron Hill replied, "Not very much. I've been averaging four hours a night for a couple of weeks." A conservative "Blue Dog" Democrat, he's been helping negotiate a bill he and other Blue Dogs could support.

The pressure is on Waxman's Energy and Commerce Committee to finish Friday because that's when the House is scheduled to recess for a month. The goal is more modest than President Obama's initial deadline of floor passage by this week, but at least Democrats could go home and report progress toward a plan. They could even talk about what's in it. Or, as the current administration theme goes, "what's in it for you."

Most Americans – make that close to 100 percent of Americans – will never sit in a hearing room as dozens of lawmakers offer amendments to one of the most complicated bills ever to come before them. I spent two hours at the session and monitored some of it online, and here's my report.

It was the 44th anniversary of the signing of Medicare, the government health plan for seniors. Every seat in the hearing room was filled. Staffers lined the walls and reporters crowded around the press table. Seven still cameras recorded the event. It was pretty boring at times, as you might expect. But to my surprise, I also found it reassuring.

It's been a very noisy time in Washington. Several new polls out Thursday showed Obama's approval ratings flagging, in general and on health care. Industry and interest groups are gearing up for ad campaigns during the recess. The packages coming together in both the House and the Senate are complicated and tentative. They'll be a challenge to explain and defend, and easy to criticize.

The Energy and Commerce members are not detached from the political currents swirling around health reform. Rep. Anthony Weiner, D-N.Y., offered an amendment Thursday to eliminate the extremely popular Medicare program – and admitted up front his goal was to embarrass Republicans who attack a proposed public insurance plan as "government-run" health care and "socialized" medicine.

"The language of criticizing government-run health care is hypocritical and dishonest," Weiner told GOP committee members. "You like government-run health care and you're just afraid to admit it."

Rep. Steve Buyer, an Indiana Republican, said Medicare was originally passed on broad bipartisan votes and called Weiner's amendment a farce. The GOP then insisted on a roll call vote. The ayes, zero. The nays, 57. It was 8 p.m. and Medicare had lived to see another day. Next up, what constitutes an emergency and who can emergency-room doctors turn away?

But even at their most heated, these people weren't shouting over each other like partisans on cable TV. They didn't insult each other. Much. Republicans weren't talking about killing health reform or, in the words of South Carolina Sen. Jim DeMint, "breaking" Obama; they were offering suggestions and amendments. And while the health debate has pitted liberal Democrats against the Blue Dogs, party leaders were hopeful they had struck a deal both sides could live with in the interests of moving things along for now.

Waxman presided with dry humor and inside jokes. After one big laugh from GOP audience members, he admonished them with a smile. "The Republicans are acting like British parliamentarians," he said. "Ration your mirth."

The bulk of what came before the committee underscored the task at hand. Health reform is about small changes and sweeping principles. It's about easy calls on care for the old and the young, and tough ones touching on rationing and illegal immigration.

There was no argument, for instance, about approving Medicare reimbursement for specialists who teach people how to manage their diabetes or waiving six-month waiting periods for infants and toddlers newly eligible for a child health insurance program.

But members struggled over a divisive GOP amendment requiring people to prove they are citizens or legal U.S. residents before receiving care under Medicaid. Waxman said rural residents without easy access to passports and birth certificates would suffer, as would people suddenly in accidents or stricken ill and taken to emergency rooms. "I imagine someone would bleed to death before you'd get the documentation," he said.

GOP Rep. Joe Barton of Texas said people are not being turned away for lack of birth certificates. Democratic Rep. Tammy Baldwin of Wisconsin countered that 19,000 people in her state were turned away "as that paperwork was being assembled."

The vote was 28 yes, 29 no. "The amendment is not agreed to," Waxman said, and one person clapped loudly. Outside the room, there were whoops and cheers. But it turned out they were from liberal health activists who had just caught a glimpse of Ohio Rep. Dennis Kucinich, a former Democratic presidential candidate. When a committee aide went out to tell them to stop making noise, an elderly woman replied indignantly, "We SHOULD be making noise."

Republicans forced another big issue with an amendment to limit the use of research into the effectiveness of medical tests and treatments. Democrats and Obama hope "comparative effectiveness research" will speed information to providers and cut down on treatments that don't work.

GOP Rep. Mike Rogers of Michigan offered an amendment saying the federal government could not use the research results to deny or ration care. He said he is passionate about the issue because he is a cancer survivor who would have "fit the criteria" to have been denied care. "One size fits all is the most dangerous way you can practice medicine. It is dangerous. People will die," he said.

"The ayes appear to have it," Waxman ruled after a voice vote. Republicans apparently were so primed for failure that they asked for a roll call vote – a request quickly withdrawn when they realized they'd won.

The deal struck by Hill and his fellow Blue Dogs involves more cost-cutting, a lighter burden on small businesses and a public plan with fewer advantages over private insurance. "It's not nearly the beast they think it is," Hill said of liberals who are angered by the compromises. But they could have the last word this fall on the House floor.

Worst-case scenario for Democrats at this point is that the committee doesn't finish the bill Friday, robbing them of momentum and a product to talk about at home. Best case, they finish it, go home and try to break through the din of conservative opposition, and come back in September to face up to the divisions within their own party.

Friday night update: The Energy and Commerce Committee approved a massive reform bill, 31-28. All three House panels handling health care have now passed bills, setting the stage for a floor vote in September.