In 2006, Jason Altmire said his No. 1 issue was the health insurance crisis and he rode into Congress on the promise to do something about it. He cited his health policy experience gained as a lobbyist for the American Hospital Association and as an executive for UPMC, and, indeed, his campaigns have been thick with donations from the health care industry.

Now that meaningful reform is in sight, however, Rep. Altmire, D-McCandless, has seemed more concerned with increasing his exposure on Fox News than helping to bring essential change to our health system.

Until recently, Rep. Altmire repeatedly reiterated the critical importance of health care reform.

In February 2009, on the crest of President Barack Obama's popularity, he declared with passion on the floor of the House of Representatives, "We as a nation spend almost $2.5 trillion on health care as a country, far more than any other country in the world; yet we still get mediocre results ... [W]e're not in the middle of the pack. We're in the bottom of the pack." He concluded, "There can be no disagreement on the need for health care reform which, once we get past this economic situation that we're in now, has to be the No. 1 course of action for this Congress."

In March 2009, he told his colleagues, "Health care cost increases are on an unsustainable course ... the time has come to act."

In June 2009, he declared that "the American people will not accept the status quo as health care costs continue to skyrocket."

In all, Mr. Altmire made similar remarks at least 10 times on the floor of the House in 2009. Then he voted against the House health care reform bill in November.

Recently accused by a Republican opponent of voting against the bill simply because it had become less popular, Mr. Altmire responded in the media: "I don't understand the criticism of, 'Well, he's voting with the district.' That's why we elect representatives."

I suppose it is too much to hope for informed and principled leadership in Congress.

Mr. Altmire also has cited the lack of cost control for his vote against the House bill and his continuing qualms about the Senate bill, which forms the basis of the proposal now nearing action. But he keeps hedging his bets, testing the political winds.

For instance, last July, Mr. Altmire told FOX News that his support for a bill would depend on the Congressional Budget Office finding "scorable savings" over 10 years. The Senate bill met Mr. Altmire's test, yet he remains steadfastly on the fence.

In September, Mr. Altmire acknowledged that an early version of the current proposal (with even fewer cost protections) "saves money over 10 years" and "we can't ever address our long-term deficit without doing health care reform."

But Mr. Altmire recently claimed on FOX News that he needs to "see a much clearer picture of the cost containment," and that he wants reform to shift "the way providers are reimbursed, to be based on quality of care rather than the number of procedures performed."

The Senate bill and the president's proposal call for such reforms, but still, unsurprisingly, Mr. Altmire offers no insight as to what level of projected savings, if any, would secure his vote.

Even accepting that more could be done to control costs, it is hard to comprehend Mr. Altmire's apparent notion that some cost containment might be worse than none.

No health care reform proposal could nearly meet any one person's highest hopes. Health care and health care politics are too complicated for that.

But unless Congress acts now on the progress it has made over the past year, the future will be bleak. Tens of millions of Americans will continue to go without health insurance while health costs swallow our economy. If President Nixon's relatively modest reforms had been enacted in 1975, we now would spend about $1 trillion less on health care per year.

The time has come for Mr. Altmire to get off the fence.

He no doubt has enjoyed the extensive airtime FOX News has provided him, thanks to his on-again, off again relationship with health care reform. But now, as Mr. Altmire himself explained in June, "this issue is too important, it is too important to this country, it is too important to families, it is too important to businesses and it is too important to every individual in this country for this not to become law this year."

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