HELENA - Ezra Klein, a prominent left-leaning blogger and journalist who covers health care and politics from Washington, D.C., was in Montana last week to talk about health care reform.

He sat down for an interview with The Billings Gazette State Bureau about the politics of health care reform, the role of Montana's Sen. Max Baucus in the effort and what the outcome may look like.

Klein, an associate editor for news-and-opinion weekly The American Prospect, profiled Baucus last fall. He'll be joining the Washington Post as a blogger next month.

Here are excerpts from the interview with the State Bureau.

Q: You recently wrote that health reformers have momentum now, but once they introduce actual bills this summer, they create a target for powerful opponents. You said "the question is whether the reform coalition is strong enough to withstand the introduction of specifics." So, is it?

Klein: I think it's an open question right now. Everything you do in reform, some people get helped, and some ox gets gored. The people who get helped don't always know it. The people who get hurt sure do. I don't think the (pro-reform) coalition has shown its resiliency yet. The problem is everybody knows how easy it is to kill major reform.

Q: We assume the health insurance industry, drug companies, medical device manufacturers and hospitals will be major opponents. Are we correct?

Klein: The insurers have always been considered problematic, (but) I don't think that's true any more. In a more efficient system (with private insurance), their volume goes up. For the others, it means the use of their products goes down. I think (the medical industry) is going to prove a much more obstinate actor when you're talking about real cost-cutting reforms than insurers are.

Q: What about Republicans in Congress? Will they be on board, or not?

Klein: There is a real logic if you're a Republican to killing this. It will be extremely hard to overcome. The minority's job is to make sure the majority party does not succeed, because every election becomes a referendum on the majority. For Republican senators to break free from that (political reality) would require a lot of courage.

Q: Sen. Max Baucus, D-Mont., is a key congressional leader on health care reform. How do you see his work on the issue so far?

Klein: I don't think he could be doing any more to try to build a coalition and pull people together and pull people into the process. He knows it's an opportunity for him to do something that no one else has been able to achieve. He's really put in the intellectual spade work. He's just been obsessive about it in a very positive way. We're seeing Baucus survey the situation and the opportunity to be a legislator in a historic sense.

Q: Baucus has said a government single-payer or Medicare-for-all system of universal coverage is not an option for reform. Shouldn't a single-payer system be considered?

Klein: There is a very strong intellectual case for single-payer. But if Max Baucus woke up tomorrow and said, "It's on the table," that's not going to make it any more likely to pass. It's not going to happen now. You couldn't pass a single-payer system. You just can't. What we found in 1994 (reform efforts) was, when politicians say, "We're going to take what you have now away, and you can trust the federal government to do this now" - that scares the hell out of people. Whatever is going to happen this year, for single-payer, the case has not been made. It's still a longer-range campaign. The question is, can (Congress) even stick their neck out far on (other reforms)?

Q: The proposed reforms from Baucus and Democrats in Congress will have some sort of mandate to buy private insurance, such as the plan enacted in Massachusetts. Yet the Massachusetts plan is proving to be much more costly than thought and still isn't covering everyone. Why should we follow that plan?

Klein: I think (the congressional plan) will have a lot more cost-control than the Massachusetts plan, a lot more reform of health care delivery. All (the Massachusetts plan) did really was increase money for access. This (congressional reform) is going to be about more; there will be a lot more happening.

Q: What are the important items we'll see in congressional Democrats' proposals?

Klein: A real effort to modernize and rationalize the system, such as payment reform. Doctors now get paid for doing more to you. The marginal incentives in the system are towards doing more, in ways that aren't always useful, and are always expensive. We're seeing a lot of ineffective treatment happening out there. That is where the system wants to find its changes. Will it? That's anyone's guess.

Q: What's the best we should hope for in health care reform this year, coming out of Congress?

Klein: The best we can hope for is something that is fairly close to a universal system: An individual mandate (to buy insurance), with (the option) of a public plan. What we really shouldn't compromise on is universality. Once you have an articulated policy of everyone being covered, then you can start figuring out how to cut costs.

You need to get the delivery system reforms right. We need real money going into evidence of what does and doesn't work. I think you need to build some alternative insurance structure.

You want to get the incentives (of the system) right. Now, it pushes you in the wrong direction: more spending and more uninsured. There's no mechanism now to cut costs.

We're at a place that we want to get it all done, but if you don't get it all done, you need at least to make it easier to get it all done, and not say, "If we don't get it all done, screw it." If you squander one opportunity, you squander a lot.

Editor's note: Klein was in Missoula last week at the invitation of Forward Montana, a nonpartisan political group active on health care reform, voter registration and voter turnout.