WASHINGTON -- What most impresses clients about health care lobbyist Frederick H. Graefe is that you can't walk three feet with him through the Capitol before running into somebody he knows.

There's the congressman who wants him to go skeet-shooting. The senator who's trying to get Mr. Graefe's witness on a public-hearing list. The House freshman chiding him about his absence from a campaign fund-raiser. The Capitol Hill police who let him double-park his Jeep while he's walking around earning $300 an hour doing business from a beeper and a cellular phone.

"He has great access," said Wayne Sinclair, general counsel for a hospital insurance company, whom Mr. Graefe squired to separate appointments with five House and Senate leaders one afternoon. "That's what it's all about: getting your views across."

Mr. Graefe, 50, fits the stereotype of the Washington lobbyist. But he is just one of the hundreds of professional pleaders trying to grab a piece of the action on health care reform while, as Mr. Graefe says, "the window is open" for deals.

More than $100 million is likely to be spent this year on a lobbying battle of unprecedented proportions over legislation that would overhaul one-seventh of the U.S. economy and affect every American. The most visible fights are being waged over such fundamental issues as how health care should be financed. But every line of the 1,300-page bill proposed by President Clinton has its own advocates and opponents pressing their views on Congress.

Advertising blitzes and phone-and-fax drives are among the principal devices for attracting attention. Yet the most effective lobbying still depends on guys like Fred Graefe (pronounced GRIFF-ee) who use personal relationships, tactical expertise, round-the-clock diligence and campaign contributions to seal a deal.

"There will always be a need for generals and quarterbacks," said Jack Bonner, head of a Washington-based firm hired by Mr. Graefe and other lobbyists to drum up grass-roots support in key congressional districts. "You need someone to design the strategy and call the plays."

Mr. Graefe has more panache than most. With his cigars, monogrammed shirts, patterned suspenders and soft tasseled loafers, he savors the role of lobbyist-hired gun, a partner in the law firm of Baker and Hostetler who represents several clients in the health care debate.

"I love the challenge of it, the amount of money at stake," Mr. Graefe said. "In a $1 trillion bill, a rounding error is worth $100 million."

As it happens, $100 million is exactly the cost of a change sought by one of his clients: a group of cardiologists who want to be classified the same as surgeons in the bill. Such a change would allow them to charge $100 million more a year in fees for performing angioplasties.

Mr. Graefe employs many old-school tactics that would be barred under the congressional gift-ban bill recently passed by the Senate. He takes members of Congress on hunting outings to Maryland's Eastern Shore. He golfs in Bethesda with members of the congressional staff. When a lawmaker's home team visits Baltimore to play the Orioles, Mr. Graefe sends along a few of the dozen season tickets his law firm holds at Camden Yards. For football fans, the lobbyist makes available his own season tickets to see the Redskins.

Mindful that power in Congress sometimes rests below the top, Mr. Graefe also sends chocolates to congressional secretaries and pizzas to committee aides when their work extends into the wee hours.

"It's all part of what you have to do to advance the cause of your clients," he said.

Even more important are the tens of thousands of dollars per election cycle Mr. Graefe raises for lawmakers' political campaigns. A small portion comes from his own pocket: about $11,000 in the two years before the 1992 elections. Much more comes from his law firm's political action committee, which anted up $35,000 in the '92 election cycle.

What lawmakers really remember is the money Mr. Graefe is able to raise by pooling donations from his clients and fellow lobbyists. He sold $40,000 worth of tickets to a Democratic Party dinner recently. That won him an invitation to a private gathering at the home of House Speaker Thomas S. Foley, a Democrat from Washington state.

It also put the lobbyist next to Senate Majority Leader George J. Mitchell in a huddle of VIPs waiting offstage to escort President Clinton into the fund-raising dinner. Mr. Graefe used the occasion to protest to Mr. Mitchell about a public comment the senator had made that seemed to doom the cause of Mr. Sinclair, who is seeking a limit on medical malpractice awards in the health care bill. The Maine Democrat, one of the five leaders Mr. Sinclair had visited with Mr. Graefe, agreed to moderate his stand.

"I wish we could operate like that," said Debbie Curtis, lobbyist for Citizen Action, a consumer advocacy group that opposes limits on medical malpractice awards. "We can't even go to political fund-raisers because we don't have any money."

Citizen Action has its own contingent of friendly lawmakers, and one of its allies in the fight to resist malpractice limits is Thomas H. Boggs Jr., a lobbyist for the Trial Lawyers Association of America. The son of two former members of Congress, Mr. Boggs has political and financial resources that make Mr. Graefe's look like small potatoes.

But Mr. Graefe's network is impressive, built through such intimate contacts as frequenting the same downtown Washington health club used by Mr. Foley. He forged a bond with Mr. Mitchell years ago when both were struggling over how to provide care for their ailing mothers.

Mr. Graefe makes it a point to be around where key lawmakers gather.

"He's one of a handful of people on health care issues who seems to be omnipresent," said Rep. Ron Wyden, an Oregon Democrat who serves on the Energy and Commerce Committee's health subcommittee.

Personal ties don't always guarantee that a lawmaker will do Mr. Graefe's bidding. Sen. Thomas A. Daschle, a South Dakota Democrat, is such a good friend that he remembers Mr. Graefe's birthday. The lobbyist is helping Mr. Daschle in his bid to succeed Mr. Mitchell as Senate majority leader.

"But I can't get anywhere with him on medical malpractice," Mr. Graefe lamented.

Similarly, a fund-raiser that Mr. Graefe arranged late last year for Sen. Daniel Patrick Moynihan didn't count at all when the lobbyist was trying to arrange this week for a witness to appear at a hearing before the Senate Finance Committee, which the New York Democrat chairs. The lobbyist had to get Sen. Dave Durenberger, a Minnesota Republican, to persuade Mr. Moynihan to override the objections to the witness raised by committee staff members.

It was a small victory. But that's how ground is gained in the health care reform battle: inch by inch.