Sen. John Breaux (D-La.) has made good use of the 15 Louisiana college football helmets that line the shelves of his Capitol Hill office.
The third-term senator from the Bayou hamlet of Crowley, La., joked that he donned them to withstand "all the people trying to beat my head in with a two-by-four" when he served as chairman of the National Bipartisan Commission on the Future of Medicare.
The 55-year-old Breaux should keep the helmets handy, because he will be a central figure this year in trying to get Congress to accept a controversial Medicare reform proposal he drafted for the commission.
That "premium support" plan proposed transforming Medicare from a system that primarily pays seniors' healthcare bills to one that pays most, but not all, of their health insurance premiums. The plan aims to use market competition to control Medicare costs and to guarantee that Medicare can withstand the influx of a projected 77 million baby boomers into the program by 2029.
Breaux said he expects to introduce his legislation before Memorial Day.
In proposing the change, Breaux is defying the political convention of his party, which has successfully used preservation of Medicare's status quo as an election issue.
Only one other Democrat on the 17-member commission, Sen. J. Robert Kerrey (D-Neb.), backed the proposal. Opposition by the other seven Democrats-including President Clinton's four appointees-kept it from getting the necessary 11 votes for formal commission approval.
It's a familiar role for Breaux, who is near-legendary in political circles for his dealmaking savvy, which contrasts with the intricate and combative policy maneuvering often engaged in by the commission's administrative chairman, Rep. William Thomas (R-Calif.).
The failure to win commission backing would appear to make congressional approval of Breaux's plan an uphill battle, but the senator-whose office is adorned with a plaque that reads "It can be done"-said he is confident he can succeed.
In fact, Breaux said he believes that if the circumstances were right, he could even win the backing of President Clinton-whom he succeeded as chairman of the moderate Democratic Leadership Council.
Those dealmaking abilities weren't enough to prevail within the commission, Breaux admitted in a recent interview. He described the commission as "doomed from the beginning" because of the 11-vote-majority requirement and because the commission debate was dominated by what he called extremists of the left and right on the panel.
That's a judgment some healthcare lobbyists share. "I think he was up against insurmountable odds," said Laura Thevenot, executive vice president of the Federation of American Health Systems. "I don't know whether the commission was designed to fail or whether the decision was made later to have the commission fail."
But Bruce Vladeck, a former HCFA administrator and one of Clinton's commission appointees, said Breaux started with a flawed strategy.
"His operating assumption was that eight Republicans were solidly behind it and that the only way to get to 11 was to get three Democrats," Vladeck said. "I always felt we could get 11 or more working from the middle out."
Breaux instead tried to pull the proposal back to the center by adding such sweeteners as a prescription drug benefit to lure Clinton appointees Stuart Altman and Laura D'Andrea Tyson on board. But in the end, they could not be swayed.
Another complication was Clinton's pledge in his State of the Union address-just weeks before the commission was required to make a recommendation-to pledge $700 billion over 15 years of federal budget surplus funds to shore up the Medicare Hospital Insurance Trust Fund.
Although acknowledging that Medicare reform will probably require more money, Breaux cautioned that "just shifting more (money) from general revenues is not really reforming (Medicare)."
But it won't be the first time the senator has bridged ideological divides on Medicare issues.
Despite facing an election in 1998, Breaux was vocal in supporting three Medicare-related provisions the Senate included in its version of the Balanced Budget Act of 1997. The provisions called for a $5 copayment on home health visits, an increase in the Medicare eligibility age to 67 and means-testing of Medicare Part B premiums. The changes were sure to spur outrage from senior groups.
The provisions were not enacted, but Breaux said he believes they would have been effective but fair checks on Medicare cost growth and beneficiaries would have come to accept them.
Too often, he said, Medicare policy has been manipulated. "I think the conventional wisdom is you don't do anything and blame the other side. Right now, we're arguing about who's to blame."