Proponents of the failed West Side stadium learned earlier this month how powerful a state legislator can be when their dreams of a football palace and potential Olympic showcase died a slow and bureaucratic death at the hands of Assemblyman Sheldon Silver.

The same could be said about a number of other lawmakers in Albany who are never likely to become household names. Take any policy against which otherwise powerful interests are unable to prevail and, in many cases, you will find a lone politician blocking the way. Why, one might ask, are publicly traded companies prohibited from owning hospitals in New York? The question came up in light of an inquiry by the U.S. Senate into the tax-exempt status of New York-Presbyterian Hospital, many employees of which take home decidedly corporate-size paychecks.

Meet Assemblyman Richard Gottfried.

Mr. Gottfried, a Manhattan Democrat, played no small part in blocking the West Side stadium. He may have been its most articulate foe. Yet Mr. Gottfried’s real power lies in his role as chairman of the Assembly’s committee on health. First elected to office as a 23-year-old law school student at Columbia University, Mr. Gottfried is, at 58, the longest-serving assemblyman in the state. His signature rep ties, canvas tote bag, and poor eyesight make him seem more like a substitute teacher than a power broker, but his influence is immense.

In shaping New York’s health policy, Mr. Gottfried controls programs that consume nearly half the state’s annual budget. He was in the Assembly nearly a decade when the prohibition on publicly owned hospitals, the only such ban in America, took effect. Repeal on his watch is not likely. “I am adamantly opposed to changing the law,” Mr. Gottfried recently told The New York Sun. “Health care guided by the profit motive inherently short-changes patients and treatments that are not profit centers. We’re not talking about hotels or selling cars. We’re talking about people’s lives.”

Mr. Gottfried is not alone in opposing competition in the health-care market. Like the controversy over the West Side stadium, in which the Republican leader of the Senate, Joseph Bruno, provided cover for Mr. Silver, Mr. Gottfried’s counterpart on the Senate’s health committee is not exactly beating a drum for publicly held hospital companies. Senator Kemp Hannon, a Nassau County Republican, said he has not seen a bill proposing repeal since a decade ago. “There was no real support for it,” Mr. Hannon said. “I found out then exactly how ingrained are the healthcare mores in New York and the belief that health care should be a not-for-profit business.”

Whether those health-care mores are strong enough to withstand more years of tax increases driven by escalating health-care costs remains to be seen. Governor Pataki failed to pass even modest cost cuts to health care in his latest budget battle with Messrs. Hannon and Gottfried. The governor’s new Commission on Health Care Facilities in the 21st Century was one of the most contentious items in the budget, with back-room disputes over its composition nearly derailing this year’s on-time performance. The details of that dispute were never made public.

The commission, chaired by the chairman of a private equity fund, Odyssey Investment Partners, Stephen Berger, was advertised as a task force on hospital and nursing-home closures. But a spokesman for Mr. Pataki, Kevin Quinn, said last week the task of commission members is “larger than that.” Mr. Quinn said repeal of the state’s ban on publicly traded hospital companies would be one of the issues the group will study. “The governor hasn’t really taken a formal position on that,” Mr. Quinn said. “But it’s certainly something we expect the commission to take a look at.”

According to Mr. Quinn, the governor and the Legislature will have to accept “all or none” of the commission’s proposals, which are due December 1, 2006. If lawmakers fail to veto the recommendations within 30 days, they become law. It’s a system like the one the federal government uses for military base closures.

So the commission will be a formidable force. So, too, is Mr. Gottfried, who cautioned me against overstating his influence. We’ll see.

Mr. McGuire is The New York Sun’s Albany correspondent.