WASHINGTON - Even as she climbed to the 14,111-foot summit of Mount Rainier, Sen. Maria Cantwell, D-Wash., couldn't escape the debate over health care reform.
Shouts of "tyranny" and "liar, liar, not true" nearly drowned out Rep. Norm Dicks, D-Wash., as he tried to answer questions during a town hall meeting in Bremerton.
After apologizing for likening town hall crowds to lynch mobs, Rep. Brian Baird, D-Wash., faced a hostile audience in Clark County where one man who compared Democrats to Nazis ended up on You Tube and Fox News.
Members of Washington's congressional delegation can't recall a summer recess filled with such passion. And the state's lawmakers say they have been listening and thinking about what they heard.
None have changed their minds as they return to Washington, D.C., this week with a showdown over health care reform looming. Democrats still support health care reform, though not all support the proposals currently floating around Capitol Hill.
With various reservations, most believe a government-run alternative to private health care insurance, a so-called public option, needs to be included in any bill.
"The vast majority of people who talk to me say they are concerned the attention is on the town halls and not the issue," said Sen. Patty Murray, D-Wash., who said health care came up virtually everywhere she went in the past month - whether riding the ferries, shopping at the grocery store or attending public events around the state.
Republicans remain steadfastly opposed to any of the bills winding their way through Congress and though they say they support the need for reform, they offer few specifics.
The state's Republicans mostly shied away from the inflammatory rhetoric heard elsewhere, though Rep. Doc Hastings of Pasco said "the biggest issue is the euthanasia part of this." Republicans have charged a House bill would create "death panels," but independent fact-checkers have said that wasn't true.
With Obama scheduled to deliver a major health care speech to a joint session of Congress on Wednesday, no other issue this fall so dominates the political landscape on Capitol Hill or with constituents back home.
"Everywhere you go people ask you about health care," said Cantwell. The senator said people in other climbing parties raised the issue during her summit climb. Despite nearly falling into a crevasse on the way down, Cantwell said "you get a different view of the world up there."
But reality beckons. As a member of the Senate Finance Committee, she will be in the middle of the health care debate. For now, she remains patient with the committee chairman's effort to negotiate a bipartisan bill with a small group of Republican committee members.
Murray also will be in the thick of it as a member of Senate leadership and the Senate Health, Education, Labor and Pensions Committee. During the recess, Murray said she was surprised to hear from so many people who had insurance but were worried it wouldn't be adequate in a pinch and that the premiums would keep rising sharply.
"The best step forward we can take is to help people feel more secure with the coverage they have," Murray said.
On the House side, Washington has two members of the House Ways and Means Committee, Rep. Jim McDermott, D-Seattle., and Rep. Dave Reichert, R-Auburn. The committee has approved a 1,000-page bill that includes the public option, provides insurance for many of the nation's 47 million uninsured and could cost more than $1 trillion. The bill will likely be changed before it heads to the floor.
McDermott is an outspoken supporter of an entirely government-run system, but says he is willing to compromise as long as any measure includes a government option.
"Why should I sit on Ways and Means and vote for $1 trillion in taxes and hand it to the insurance companies and tell them to insure everyone?" he asked. "That's like believing in the tooth fairy."
Reichert voted against the committee's bill, saying in a statement the public option was the "wrong prescription for health care and our economy." He was unavailable for an interview, but spokeswoman Abigail Shilling said he has held two telephone town halls and met with various constituent groups.
Lawmakers say the single most important issue for Washington is the need to overhaul the Medicare reimbursement rate formula that punishes the state because it has one of the most efficient health care systems in the nation. The money goes to doctors, hospitals and other providers. But because of the low reimbursements, a growing number of doctors refuse to take Medicare patients and the state has had trouble attracting new doctors.
"We need to adjust the formula to start rewarding states with efficient systems and stop supporting states that don't," said Rep. Rick Larsen, D-Lake Stevens, whose town hall in an outdoor stadium in Everett was attended by 2,700 people. Larsen said the crowd was about evenly divided between health care reform supporters and opponents.
With $1 in every $5 spent on health care nationwide coming through the Medicare system, Larsen and others say changes in the reimbursement rate could be the first step in reining in health care costs nationwide. And, they say a public option that does away with the current system and favors quality health care service over quantity would force private insurers to lower their rates.
Without lowering health care costs, the state's lawmakers say it may be impossible to provide coverage to those without health insurance, including an estimated 830,000 in Washington.
As Congress adjourned, Baird attracted national attention by saying he wouldn't be holding any in-person town hall meetings because opponents of health care reform were trying to "intimidate" supporters by disrupting such meetings. Baird later apologized for his remarks and convened five town halls. Though he took a beating at the Clark County town hall, Baird said later ones were more civil.
"My views are evolving," Baird said. "It's not what happens if we do pass a bill; it's what happens if we don't."
The state's Republican lawmakers adamantly oppose any public option and remain concerned about the costs of the Democratic reform proposals with the federal deficit at record levels.
Hastings told the Tri-City Regional Chamber of Commerce the answer is offering consumers more choices, but not a government-funded one. A public option subsidized by tax dollars would eventually drive private health care insurers out of business.
"I truly believe it will lead to a government-run health care system and that runs counter to what America is all about," Hastings said. "I think we have a very good health care system in this country."