Senator Eliot Shapleigh - El Paso, Texas

Tom Daschle

WASHINGTON — Former Senator Tom Daschle pledged on Thursday to work with lawmakers of both parties in a grass roots, ideology-free campaign to revamp the nation’s struggling health care system.

“We will be guided by evidence and effectiveness, not by ideology,” Mr. Daschle told the Senate Committee on Health, Education, Labor and Pensions after saying that he wanted “to work with each of you” on ways to improve health care for all Americans.

“When it comes to health care, we really are in it together,” Mr. Daschle said, adding that to do nothing — or too little — about the spiraling costs of health care, the growing legions of the uninsured and substandard medical treatment in some areas is simply unacceptable.

Mr. Daschle, the South Dakota Democrat and former majority leader, said conversations with ordinary citizens and with business leaders had driven home the depth of the problems related to health care. He said he had been struck by findings that General Motors spends more on health care than it does on steel, and that Starbucks spends more on health care than it does on coffee.

Mr. Daschle, who appeared before the Senate panel as projections emerged that the federal government faces trillion dollar-plus budget deficits, said the recent trend of health care spending running far ahead of inflation is “as unsustainable for our national budget as it is for a family budget.”

Mr. Daschle pledged to avoid ideological factors in making policy decisions, and later during a question-answer session promised to give department scientists “the autonomy they need” and insulate them from “factors having nothing to do with science.”

Although he did not say so explicitly, Mr. Daschle was clearly drawing a contrast with the Bush administration, whose critics often accused it of mixing science and medicine with personal beliefs on issues like stem cell research, abortion and sexual behavior.

As a former senator with friends on both sides of the aisle, Mr. Daschle was greeted warmly by panel members (“Welcome home,” said Senator Richard Burr, Republican of North Carolina), and his confirmation seems all but assured.

The committee chairman, Senator Edward M. Kennedy, Democrat of Massachusetts, called Mr. Daschle “just the person for the job.”

Mr. Kennedy quoted Mr. Daschle’s own words as he bade farewell to the Senate four years ago: “Will we honor the uniquely American ideal that we are responsible for passing this country on to a generation in the future that is better? Or will we forfeit the promise of the future for the reward of the moment?”

Mr. Daschle was introduced by former Senator Bob Dole, a Republican from Kansas, who said Mr. Obama had chosen well because Mr. Daschle “really understands, almost as well as staff experts, most of the issues when it comes to health care.”

“I was around here for quite a while, and I have a sense that the time has come for real, constructive bipartisan action on health care,” Mr. Dole said. “The American people and Congress are ready to address this particular issue about the uninsured and accessibility, affordability, the spiraling costs.”

Notwithstanding the friendly atmosphere, Mr. Daschle and the committee members were sure to engage in spirited discussions about one of the most contentious aspects of President-elect Obama’s domestic agenda: his call for a new public health insurance plan to compete with private insurers.

No other proposal so clearly defines the political and philosophical differences between Mr. Obama and Republicans, or provokes such deep disagreements.

Mr. Daschle, the point man for Mr. Obama’s campaign to revamp the health care system, supports the concept of “a government-run insurance program modeled after Medicare.” It would, he says, give consumers, especially the uninsured, an alternative to commercial insurance offered by companies like Aetna, Humana and WellPoint.

But the proposal is anathema to many insurers, employers and Republicans. They say the government plan would have unfair advantages, like the ability to impose lower fees, and could eventually attract so many customers that private insurers would be driven from the market.

“The public plan option is a terrible idea — one of our top concerns in the health reform debate,” said James P. Gelfand, senior manager of health policy at the United States Chamber of Commerce.

The public plan, as conceived by Mr. Obama, would vie with private insurers to provide better benefits and better customer service at a lower cost. Without such competition, Democrats say, private insurers cannot be expected to control costs much better than they do now.

Jacob S. Hacker, a professor of political science at the University of California, Berkeley, said the new option was essential to the success of Mr. Obama’s effort to rein in costs and make coverage available to all Americans.

“Public insurance has a better track record than private insurance when it comes to reining in costs while preserving access to care,” Mr. Hacker said. “The public plan would set a standard against which private plans must compete.”

Jeanne M. Lambrew, an associate professor at the University of Texas who is in line to be deputy director of a new White House Office of Health Reform, asks: “Why should policy makers give private insurers the exclusive right to cover Americans? If private insurers can better meet our goals for the health system, why object to a level competition with public plans?”

The idea of a public plan has been endorsed by two Democrats with a decisive say on health legislation: Senator Max Baucus of Montana, chairman of the Senate Finance Committee, and Representative Pete Stark of California, chairman of the Ways and Means Subcommittee on Health.

Two of Mr. Obama’s rivals for the presidential nomination, John Edwards and Hillary Rodham Clinton, also wanted to give people a choice between private insurers and a public plan modeled after Medicare.

“Over time,” Mr. Edwards said, “the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.”

That is what worries insurers, employers and Republicans.

“Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program,” said Senator Michael B. Enzi of Wyoming, the senior Republican on the committee.

Senator Olympia J. Snowe of Maine, a moderate Republican, shares some of that concern. “Creation of a government plan is no panacea,” she said, and “could disproportionately shift costs from private plans to the public.”