On health care reform, there's a whole lot of talking going on in Washington.

But this time, there is a real sense among Catholic advocates that the talk will produce a substantive legislative proposal --- or two --- that could come up for a vote in the Senate and/or House by this summer.

"Health care is rising to the No. 1 domestic priority for Congress," said Kathy Saile, director of the Office of Domestic Social Development at the U.S. Conference of Catholic Bishops.

"We're very hopeful that significant health reform is going to happen," said Jeff Tieman, senior director for health reform initiatives at the Catholic Health Association. "But it's not a home run yet. We're cautiously optimistic."

Two of the primary movers of health care reform in Congress are Sens. Max Baucus, D-Mont., and Chuck Grassley, R-Iowa, who heard more than a dozen witnesses at an April 21 round-table discussion on reforming the U.S. health care delivery system. Baucus and Grassley are chairman and ranking member, respectively, of the Senate Finance Committee.

Scheduled for May are similar discussions on expanding health care coverage to all Americans and financing health reform.

"We're going to go somewhere with this," said Baucus at the close of the first round table. "Something's going to happen here."

But what that something is remains very much in question. President Barack Obama has outlined only the general principles for what he'd like to see in a health care reform plan, and his administration is leaving the drafting of legislation to Congress.

One bump in the road was the Senate's battle over approving Kansas Gov. Kathleen Sebelius, Obama's nominee for secretary of the Department of Health and Human Services. Sebelius, a Catholic, has drawn criticism for her support of abortion and for taking campaign contributions from late-term abortion doctor George Tiller.

The Senate finally confirmed her by a 61-35 vote April 28. But with or without Sebelius, dialogue about health care reform was continuing at all levels in Washington.

The biggest debates focus on the so-called "public option" --- the inclusion of a government-financed health plan that would compete with other insurers to provide coverage. Mike Leavitt, who was HHS secretary under President George W. Bush, joined in the discussion during an April 22 conference call.

"The 'public option' is presented as a means to promote competition and choice but would prove fatal to both," Leavitt said, predicting that employers would stop providing health coverage for their employees if they could opt out.

That's not an aspect that the bishops' conference has ever weighed in on, Saile said.

What the bishops have insisted on in any health reform plan hasn't changed much since they outlined key principles in 1993 during the debate over President Bill Clinton's health reform plan, she said.

They want to see a health system that makes care available to all in a way that "enhances and respects life," exhibits particular concern for the poor and vulnerable, respects pluralism and conscience in providers' and consumers' choices, and is financed equitably, Saile said.

Similarly, Catholic Health Association leaders spelled out their expectations in the 2008 document "Our Vision for U.S. Health Care." It calls for a system that is available and accessible to everyone; health- and prevention-oriented; sufficiently and fairly financed; transparent and consensus-driven in allocation of resources; patient-centered and designed to address health needs from conception to natural death; and safe, effective and high-quality.

The Health Security Index survey commissioned by Catholic Healthcare West, a San Francisco-based system of 41 hospitals in California, Arizona and Nevada, found that concern about health care is growing.

For the first time since the annual survey began two years ago, the majority of respondents said the U.S. health care system is getting somewhat or much worse. Despite the nation's dire economic situation, nearly twice as many U.S. adults were concerned about the rising cost of health care than were concerned about losing their jobs.

The margin of error for the survey was less than plus or minus 3 percentage points.

More than four in five respondents (83 percent) said making health care affordable for every member of society should be one of Congress' top priorities for the coming year.

"Today's headlines are justifiably focused on the overall economic crisis, but our Health Security Index findings show that health care affordability is a significant and enduring concern," said Lloyd H. Dean, president and CEO of Catholic Healthcare West and current president of the CHA board of trustees.

"Simply put, health care costs too much," Dean added. "Change is clearly overdue and the need for improvement is undeniable."

Tieman said it is important for Catholics to contact their representatives in Congress to tell them to "keep the health reform issue front-burner" and to "lend a faith-based voice to the debate."

It's also crucial to keep informed about developments in the discussions, he said.

"So much misinformation gets out there," Tieman added. But when specific legislation is about to come up for a vote, he said, those who "stay on top of" the debate "will understand whether they support it or not."

----CNS