Office of Management and Budget director
A classic Washington wonk, he has total command of health-care statistics and coin-of-the-realm credibility with a lot of key constituencies: Congress, the health-care industry, the media and the President. His reputation as a well-meaning technocrat, rather than an ideologue, appeals to the right, while his long-standing sway with the left gives the Administration cover as it seeks a negotiated settlement. Mellow and diligent, he will be in the room as the final compromise plans get floated and will pass judgment about what is cost-effective and what would break the bank. He makes the case as well as anyone that the country can't afford not to fix the overall health-care system — in the end, the essential argument if a bill is going to make it to the Oval Office.