"We will consider all kinds of options," Frist said. He also urged Democrats to "come to the table."
Democrats, however, are not budging. "I would respectfully suggest that they [Republicans] don't want a deal on this issue," Manley said. Republican leaders have been unwilling to show flexibility on key points such as the cap on punitive damages, he added, which suggests that they want to use the issue more as a rallying cry for its interest groups rather than as a legislative achievement.
The deep-pocketed trial lawyers' lobby is mounting a major drive to prevent the bill from moving forward. The Association of Trial Lawyers of America (ATLA) has been raising millions of dollars to combat the medical malpractice proposal and has hired additional congressional lobbyists to keep the pressure on lawmakers to reject the president's plan.
Bush proponents "are holding a lot of the cards, so we will be vigilant throughout the year," said Linda Lipsen, ATLA's chief lobbyist. But, she added: "They're short of votes now."
Quick passage of the class-action bill, which Bush signed into law Feb. 18, was "both good and bad news," a senior business lobbyist said. It was good for industry that class-action legislation passed at all, he said, because it represented a small but meaningful victory over the hard-to-defeat plaintiffs' bar. But it was bad news, he added, because many lawmakers are loath to whack the powerful trial-lawyer lobby more than once in a single year.
Lawmakers' reluctance to attack trial lawyers also impedes Bush-supported efforts to restrain the flood of lawsuits against companies that once manufactured asbestos products. The president has urged Congress to slim the huge asbestos docket. But defendant companies and their insurers have remained unable to agree with unions and trial lawyers on a funding level and a few other key issues in a proposed asbestos trust fund. As a result, that Bush priority has also been laid aside.
The Senate has no plans to act anytime soon on the medical malpractice bill. A senior staff member on the Senate Judiciary Committee said the panel has been too immersed in the recent bankruptcy bill and trying to find a settlement on asbestos claims to expect movement on medical malpractice this month or next -- unless Frist intervenes to jump-start the issue.
Bob Stevenson, the majority leader's spokesman, did not dispute the uphill odds, but said the legislation remains a priority for Frist. "The majority leader clearly feels this is a crisis, affecting both the cost and access to health care."
Frist has made some efforts to reach out to Democrats, Stevenson said, but he declined to offer any details about potential bargains. "We have not found the mother lode, but we are finding some areas of common ground," he said.
There is reason to wonder how robust this outreach has been. Last year, Sen. Dianne Feinstein (Calif.) was one of the key Democrats who worked with Republicans in a failed effort to craft a compromise. So far this year, no Republicans have reached out to Feinstein to repeat that effort, said Howard Gantman, her communications director.
In the meantime, said Sherman Joyce, president of the Republican-leaning American Tort Reform Association, "The challenge of getting 60 votes in the Senate is going to be tough."