The spiraling costs of medical procedures and the swelling ranks of the uninsured have pushed this country to the brink of a health-care crisis.
   If re-elected, Utah Sen. Orrin Hatch will sit in the center of that storm. In 2008, Hatch is expected to oversee the Senate committee in charge of Medicare, Medicaid and other government health programs.
   He vows total reform and advocates for consumers, the poor and the old hope he can deliver, though they remain wary.
   They applaud his efforts to obtain health insurance for low-income children, yet say insurance plans he promotes only benefit the wealthy and healthy.
   They support his fight for embryonic stem cell research, but argue he sides with the pharmaceutical companies too often.
   Still, few other political leaders would be better situated to revamp American health care.
   
   Political will: "It is just how much leadership is he willing to bring and how much political capital is he willing to expend," said Karen Crompton, executive director of Voices for Utah Children.
   Hatch's Democratic opponent, Pete Ashdown, says the senator lacks the "political will" to initiate true reform, questioning his ties to the pharmaceutical industry and insurance companies.
   "I certainly don't want to characterize Senator Hatch as being beholden to those companies, but his actions indicated otherwise," he said.
   Ashdown and others, including AARP's Rob Ence, feel Hatch helped the pharmaceutical industry by limiting states' ability to negotiate cheaper drug prices in the new Medicare prescription drug plan. Hatch calls this a "fairy tale."
   Breaking down Hatch's campaign donations by category, he receives more from the health-care industry than any other group, according to Political Moneyline, a Web site that tracks donations.
   During the current campaign cycle, Hatch has collected more than $312,000 from pharmaceutical companies - more than every politician except Pennsylvania Republican Sen. Rick Santorum. He ranks No. 1 on dietary supplement donations, according to the Center for Responsive Politics.
   Hatch said the money is a recognition of his work in the health care arena, which he promised to continue.
   He said he will strive to "find some way of reforming, revitalizing, reorganizing our health care system so we can provide health care for everybody."
   
   Unsure of a plan: He just doesn't know exactly how to do that yet. One idea he has dismissed is any government-run universal health care program.
   "We have even more problems when the almighty federal government comes up with a top-down, one-size-fits-all solution," he said.
   Hatch and Oregon Democrat Sen. Ron Wyden created the Citizens Health Care Working Group in 2003, which sent 14 experts around the country looking for solutions.
   They released their recommendations this fall. President Bush and Congress have yet to respond.
   Brent James, vice president of Intermountain Healthcare, was a member of the group. He said the experts concluded Americans believed universal health care was a "shared social responsibility," and that everyone deserved a basic benefits package they could take from job to job.
   Most people also opposed a government-run program. James is instead calling for Congress to create an independent board, which would decide what to include in a basic package and then require all insurance companies to offer the plan. Those not covered would receive help from expanded Medicare and Medicaid programs.
   Hatch would not comment on these recommendations, saying he hasn't had time to digest the report. But James has talked to Hatch about his ideas and said "Hatch hasn't bought on."
   Ashdown backs the working group - though with a twist.
   "We need a national health care insurance system," he said.
   Ashdown wants to scrap existing government programs and create one new omnibus plan.
   Hatch criticized Ashdown's idea, saying the programs are already interconnected and that one big program would be harder to keep track of.
   
   Priorities: Before tackling widespread reform, Hatch said he will fight to reauthorize the highest profile health-care program he helped create.
   A decade ago, Hatch joined with Massachusetts Democrat Ted Kennedy to create the Children's Health Insurance Program (CHIP).
   CHIP covers children who don't have health insurance but don't qualify for Medicaid.
   In 2007, Congress will have to reauthorize CHIP or the program will die. Health care advocates such as Utah's Judi Hilman are counting on Hatch to lead the charge.
   Hilman, who is the executive director of the Utah Health Policy Project, would like to see CHIP expanded to help the 8 million children who still do not have health insurance, but she said keeping CHIP stable would be a challenge on its own.
   CHIP will cost $12 billion to $14 billion over the next five years. Hilman and Crompton worry Congress will try to carve that money out of Medicaid.
   To cut health care costs, Hatch is touting embryonic stem cell research. He envisions a future where stem cell therapies ward off or even eliminate the need for heart transplants, knee replacements or back surgery, while battling diabetes and Parkinson's disease.
   "It will take upwards of 20 years to reach major success," he said. "But it may be the answer to a lot of health care costs."
   At least among health-care advocates, Hatch has support on stem cells. But that support breaks down when he touts the cost-saving ability of health savings accounts.
   These accounts allow employers and employees to contribute tax free and are usually connected to plans with low monthly premiums and high deductibles.
   Hatch said the relatively new plans, which now cover 1 percent of Americans, require individuals to take more responsibility for their health care, cutting down on unnecessary doctor visits. The plans also save money for small businesses.
   But Ron Pollack, executive director of the nonpartisan consumer group Families USA, calls the accounts "bad health care."
   The health savings accounts would disproportionately benefit the wealthy, he said. Also, high deductibles could make people think twice about medical care.
   "I would like to see us take some kind of leap to some sort of sustainable, cost-effective health care delivery system," Hilman said.
   And Hatch says he's the man for the job: "The health care system needs reconstructive surgery."
    mcanham@sltrib.com