WASHINGTON -- Rep. Benjamin L. Cardin, once a youthful star of Maryland politics, is starting to shine at the national level.
The same combination of political instincts and policy smarts that won him the post of House speaker during a 20-year career in the General Assembly has made the Baltimore Democrat an influential player in the health care reform debate after seven quiet years on the congressional back benches.
As Congress knuckles down to the nitty-gritty work of one of the most ambitious and complex undertaking in decades, Mr. Cardin, 50, is being acknowledged as one of its leading authorities.
"He's very, very interested in the details of the substance, which is refreshingly different from a lot of people around here," said lobbyist Thomas A. Scully, a former Bush administration official who represents insurance companies, doctors and other clients.
More senior colleagues, such as Democratic Rep. Robert T. Matsui of California, tell reporters who pose health care questions that they should talk to Mr. Cardin because he knows the subject better.
Rep. Richard A. Gephardt, D-Mo., the House majority leader, named the Baltimore congressman to an informal group that is looking for compromises behind the scenes.
And Hillary Rodham Clinton, who has identified Mr. Cardin as a valuable ally in the campaign to pass her health care plan, was eager to add her own tribute.
"He's one person who has actually read the whole bill the president proposed and really understands it," she offered in a recent telephone interview. "That makes his advice so valuable on policy and politics alike."
A social liberal with strong pro-business sympathies, Mr. Cardin hasn't pleased everyone with his actions on health care reform. But there's no doubting his impact.
As a pivotal member of the powerful House Ways and Means Committee, he is positioned to play a major role in drafting and brokering what he believes will be the most important legislation ever see.
His fingerprints are already all over the first draft of the measure -- produced last month by the Health Subcommittee.
"He carries 20 or 30 votes with him because guys look up to see which way he goes on these issues," said Frederick H. Graefe, a lobbyist representing doctors and drug companies. "Ben is definitely one of the key players in this whole debate."
Mr. Cardin says the opportunity to shape health reform was so important that he refused entreaties from supporters to make a rTC bid for governor this year -- even though a poll he took indicated his prospects for victory were good.
It's not clear where the congressman's growing prominence might take him.
Even with expected vacancies next year on Ways and Means, he'll still probably rank only 11th out of 24 Democrats in seniority -- with a long wait for even a subcommittee chairmanship.
The seniority system in Washington forces even the most talented junior members to wait their turn for advancement.
But Mr. Cardin says that for the moment, at least, he is content to have an impact on policy issues he cares about.
During the debate by the Ways and Means subcommittee last month, Mr. Cardin took a leading role on several aspects of the health reform plan.
He pushed to restrict the amount of money patients can win in medical malpractice lawsuits, worked to give Maryland and other states more flexibility to impose their own health reform systems, and sought to assure that businesses would not have to pay more if they wanted to give their workers a choice of health insurance plans.
He has also worked on such details as increasing mental health benefits under the plan and adding coverage for lead-paint and colon-cancer screening.
Not everyone is happy with the results of his efforts, however.
Lobbyists for liberal groups say Mr. Cardin is too concerned with protecting business interests, too reluctant to raise taxes to pay for health care, too interested in advancing his own career.
"He played a very negative role. It was not the Ben Cardin I'm used to seeing," said Sara Nichols, chief counsel for Public Citizen, a group founded by Ralph Nader. "I guess that reflects the difficulty of this issue. People like him go around saying they are for universal coverage, but they aren't willing to do what it takes to pay for it."
Much to the dismay of advocates such as Ms. Nichols, Mr. Cardin refused to support the single-payer health care system that would put everyone under one government program financed by tax revenue.
He, like President Clinton, believes it would be more politically practical to build on the current system, in which most people get their health insurance through their employers.
But Mr. Cardin also refused to back a payroll tax to help subsidize benefits for poor people, opting instead for a compromise scheme -- expected to be changed later in the drafting process -- that would cut benefits instead.
While he supports Mr. Clinton's proposal requiring employers to pay 80 percent of the cost of health insurance for their workers, Mr. Cardin says he will push for easier treatment of small businesses that may not be able to afford the ex
pense. And he makes no apologies for looking out for them.
Mr. Cardin's key vote to support a limit on malpractice awards came as a surprise to opponents who were unaware of his long-standing support for such caps.
The Baltimore lawyer joined with four Republicans and one conservative Democrat on the 11-member Health Subcommittee to cast a deciding vote in favor of limiting "pain and suffering" awards to $350,000, a limit similar to one he helped impose in Maryland eight years ago.
"It was an awful vote. I was shocked," said Debbie Curtis, a lobbyist for Citizen Action, a liberal advocacy group. "What that means is the most aggrieved parties in malpractice cases basically have no recourse in the courts. Often lawyers won't even take their cases because the limits aren't much above what it costs them in expenses."
But Mr. Cardin says he believes too much of the money awarded in malpractice cases goes to lawyers and their coterie of expert witnesses, consultants, investigators and others brought into the litigation.
Another Cardin provision, allowing states to go their own way on health care reform, is "a disastrous idea," said George Pantos, a lobbyist for self-insured companies that don't want to have to deal with a hodgepodge of state regulations.
But he acknowledged it is a notion that appeals to conservative Democrats and Republicans and seems to be gaining steam in Congress.