Jason Altmire had a ground-level view of how it all went wrong the last time during a major national effort to overhaul health care.
The stumbles and ultimate failure of President Bill Clinton's health care reform plan in 1993 provided a valuable lesson in Capitol Hill politics to Mr. Altmire, then a 25-year-old congressional staffer.
Sixteen years later, the second-term Democratic congressman from McCandless has a vote and a strong voice in the debate over health care reform -- both from a career spent in health care policy and politics, and his position as a Blue Dog Democrat representing a swing district.
Mr. Altmire voted against the House health care reform bill in the Education and Labor Committee -- primarily, he said, because of costs. But he said he is in line with President Barack Obama's plans to provide universal health insurance and would vote for a bill that is deficit-neutral.
Mr. Obama's speech to a joint session of Congress on Wednesday drew comparisons to one from Mr. Clinton, though the process and substance of reform is a stark departure from the plan overseen by then-First Lady Hillary Rodham Clinton.
In 1993 Mrs. Clinton formed a task force to examine how to enact universal health care coverage that included policy experts but also Democratic congressional staffers. Among them was Mr. Altmire, who after graduating from Florida State University in 1990, took a job with Florida Democrat Pete Peterson first in his campaign and then in Washington as a legislative aide.
Mr. Altmire said he took an interest in health care because, then as now, it was "the big issue of the day." When the task force sought input from centrist Democrats, Mr. Peterson -- a moderate who represented the Florida Panhandle -- assigned Mr. Altmire to join it.
"The Clinton people, and it's very similar to what you see going on now, they saw they had a problem with the [more] conservative base" of the Democratic Party, Mr. Altmire said.
"To appease them, they appointed a few staff members from those members to seats on the committee, the task force. So we were always viewed with a bit of skepticism."
The staffers were assigned to different policy areas and conducted research to feed information to the White House about the kinds of policy that would be successful -- as well as politically palatable in their moderate districts. But according to David Kendall, who worked on the task force for former Rep. Mike Andrews, of Texas, their work was a façade.
"We all thought it was sort of a boon, the influence we had, but it turned out we had no influence," said Mr. Kendall, now a policy analyst at progressive think tank Third Way.
"It was more like they were just letting us spin our wheels. So while they could get their act together. As we know, they didn't really get to ever negotiating solutions."
As staffers began to realize that their role would not be as influential as they'd hoped, Mr. Kendall said many of them got frustrated -- but not Mr. Altmire.
Mr. Kendall said. "He went about taking everything in stride. It was pretty remarkable that as such a young staffer he was able to keep everything in perspective."
Susan Emmer, who worked on the task force for Florida Sen. Bob Graham, noted Mr. Altmire's even temperament and uncommon knowledge of political history. She also knew Mr. Altmire well from working with him for the Florida delegation.
"When most of the people who worked on the Hill were smart and motivated and had political aspirations, he had some depth that I thought was unique," said Ms. Emmer, now a health care lawyer and lobbyist. "And determination."
The experience provided a valuable Capitol Hill education for Mr. Altmire, who noted how the White House gave lip service to legislators but still tried to impose its will by essentially handing a 1,300-page bill to Congress and ordering its passage.
"It was clear [the White House was] trying to do everything all at once, and even I knew at the time that in districts like the one Peterson represented, it had no chance of getting political support," Mr. Altmire said.
"The biggest mistake they made was not consulting with people who were in the end going to have to pass it through the legislative process."
Serving on the task force also fueled Mr. Altmire's interest in health care policy. He went to school at night to earn a master's degree in health administration from George Washington University. He left Mr. Peterson's staff in 1996 to work as a lobbyist for the Federation of American Hospitals, which represents for-profit hospitals.
After 21/2 years at the federation, Mr. Altmire, a North Hills native, got the chance to move home when he took a job in government and community relations at UPMC. He served the hospital system as a lobbyist and also helped to coordinate its charitable efforts.
George Board, who recruited Mr. Altmire to UPMC and was his boss there, said Mr. Altmire's political skills and health care knowledge helped him translate for lawmakers what physicians and researchers were doing, and vice versa.
"It requires a huge amount of tact and compromise and balancing, and Jason was excellent at that," Mr. Board said. "He really has a unique temperament."
When Mr. Altmire told Mr. Board he was thinking about running for Congress in 2006 to try to unseat Republican Melissa Hart in the 4th District, Mr. Board encouraged him. Mr. Altmire, riding a nationwide tide as Democrats retook the House of Representatives, won the election, then triumphed by a wide margin in a rematch in 2008.
Now, once again, he is in the midst of a fight over health care reform. Mr. Altmire serves on the Education and Labor Committee, one of three in the House with jurisdiction over the health care legislation.
During the committee process, Mr. Altmire said he felt committee leaders gave more weight to his input than they might have to another second-term Congressman -- but more because of his political situation than his policy experience. Serving a second term in a moderate, partly rural district, Mr. Altmire's situation is remarkably similar to that of Mr. Peterson in 1993.
"I am a member who comes from a district that politically is not certainly left of center, it is centrist," Mr. Altmire said of his territory, which includes all of Lawrence County, most of Beaver County and parts of Allegheny, Butler and Mercer counties.
"These are the districts where they'll have to have support. When I talk about what I see when I travel around, I think it carries extra weight. I know through the Clinton experience the politics as well as policy. ... What I bring to the table is the ability to bring some consensus with this issue."
Mr. Altmire and his fellow Blue Dogs -- a fiscally conservative caucus of Democrats -- were a key force in delaying health care legislation in the House and preventing lawmakers from meeting Mr. Obama's end-of-summer deadline to produce a bill. Mr. Altmire said that was a good thing because it brought healthy debate during the August Congressional recess.
But after Mr. Obama's speech last week, Mr. Altmire said he was optimistic that a bill would be passed and that he would support it -- if a final version does not add to the deficit, as the President pledged.
Until Mr. Obama's speech, the White House had been careful to let Congress work and not repeat the mistakes of the Clinton task force -- though Mr. Altmire said the administration may have gone too far, as the House bill has brought backlash for being too liberal.
He heard such complaints himself last month, particularly during a boisterous town hall event in Farrell, Mercer County.
"They swung that pendulum back to the opposite extreme and encountered an equal and opposite opposition," Mr. Altmire said. "Now they're trying to put the toothpaste back into the tube."
As the legislation is altered and re-altered in the coming weeks and months, Mr. Altmire said he believes his extensive background in policy and his work for both for-profit and nonprofit hospitals have been assets. But he said his stint on the unsuccessful Clinton task force provided the most pertinent experience to guide him through the difficult politics of health care reform.
That perspective, his former boss said, could help the congressman move the debate to a conclusion.
"This is a huge and incredibly complex area, and in some respects Jason is uniquely suited to have an impact from a knowledge standpoint," Mr. Board said. "You need people like that to work out a reasonable compromise because nothing you do is going to make everybody happy."