State Initiatives Seek Overhaul of Health Care
By CAREY GOLDBERG, The New York Times
June 10, 2000
BOSTON, June 10 -- They were gently spoken and kind-eyed in their white
coats, but make no mistake: the handful of doctors and nurses gathering
signatures outside the Massachusetts Statehouse see themselves as part of a
popular health care insurgency, and some medical powers are taking them
seriously enough to spend millions of dollars trying to stop them.
With one final petition drive this weekend, a coalition of doctors, nurses,
senior citizens' groups, labor unions and others is expected to collect the
last several thousand signatures needed to place before Massachusetts voters
what experts call the most sweeping health care referendum on any state's
ballot this fall.
Seeking to tap into widespread discontent with inaction by Congress and the
Statehouse, the referendum would require the Legislature to find a way to
provide health insurance coverage for all by mid-2002 in a state where more
than 600,000 people lack it. It would also introduce a patients' bill of
rights that would guarantee patients the freedom to choose their doctors and
guarantee doctors the freedom to choose the right treatment for their
patients. And it would put a temporary ban on the conversion of nonprofit
hospitals to for-profit.
Similar white-coat rebellions are in the works elsewhere: campaigners in
Washington State, too, are close to getting a measure calling for universal
health care onto the state ballot for this fall, which would make this the
first campaign season in which more than one state had a universal care
initiative on the ballot, experts say.
In a handful of other states -- Arizona, Arkansas, Oklahoma and Montana --
campaigns backing narrower health care proposals, like requiring tobacco
settlement money to go toward health, are using ballot initiatives as well.
"What is happening is an enormous backlash by the public," said Dr. Bernard
Lown, a Nobel prize laureate and a leader of the Massachusetts initiative
drive.
A push to overhaul the health care system, he said, "has to come from below,
from the state level; you're closer to the people, you're closer to their
pain, and they're more readily mobilized."
He and other campaigners say they believe a convergence of several factors is
at work in their favor. They point to the swelling numbers of uninsured
people, the trouble that many patients have paying for their prescription
drugs, the spiraling costs of medical care and the widespread complaints from
doctors and nurses that new constraints are keeping them from offering the
best care to their patients.
The opposition appears readily mobilized as well.
Here in Massachusetts, the Coalition for Health Care, which is running the
ballot campaign, is already opposed by the Committee for Affordable Health
Care Choices, which unites business associations, managed care organizations
and other insurers.
"We're just getting into campaign readiness," said Richard C. Lord, its
spokesman and president of the state's biggest business association. "But
it's probably going to take millions of dollars, because if you want to get yo
ur message across to the voters, you need to advertise and that's very
expensive."
His group's message, he said, will include the points that the initiative
could destroy the networks that are the very basis of managed care, and could
throw the health care system into chaos by the beginning of next year.
The committee also argues that the initiative is overly vague in that it
calls for universal health care but does not specify how it is to be paid
for. Several commissions in recent years have been stymied by the question of
who would pay that bill, Mr. Lord noted.
The initiative's backers counter that the vagueness was intentional, because
it allowed the formation of a coalition that included those who favor a
Canadian-style single-payer system, those who favor a Hawaii-style
requirement that employers provide health insurance, and others.
"People have been specifying the funding mechanisms forever, and they've been
losing," said John O'Connor, the campaign's co-chairman and a veteran
campaigner for environmental causes. "We want to keep the majority of voters
together on the concept that everybody has to be covered by a date certain,"
July 1, 2002.
Judging by polls and the signature-gathering outside the Statehouse on
Friday, support is indeed broad for the general idea of universal coverage.
A few passers-by withheld judgment, but several signed with alacrity. "I'm
definitely for universal health care," said Shuang Wang, a 21-year-old intern
at the Statehouse, "though I don't know where the money is going to come
from." Another signer, Tom McCarron, a lobbyist on transportation issues,
said, "I just think it's vitally important that people be covered for health
care. The cost of it is just out of control."
Proposals for universal coverage have been made repeatedly in recent years
around the country, since well before the Clinton administration tried to
overhaul the country's health care system in the early 1990's.
In liberal Massachusetts, a universal health care proposal was even enacted
into law in the late 1980's, though the Statehouse went from Democrat to
Republican and the economy from flush to hard up, and the measure was
repealed before it took effect.
Usually, measures calling for universal health care and other sweeping
changes have tended to go down to defeat, said Diane Lardie, national
coordinator of Uhcan, the Universal Health Care Action Network, a national
group based in Cleveland. They have come up in more than 20 states beginning
in Ohio in 1989, Ms. Lardie said, but usually either failed to make it onto
the ballot or died in a legislative committee or on the floor of one house or
another.
"One of the difficulties with something like a health care issue is that
health care is so complex that people are scared," she said, "and they're
willing to say, 'Don't do anything,' as opposed to 'Change it for the better'
because they're afraid it won't be for the better."
The Massachusetts and Washington State initiatives are important bellwethers
to gauge whether public opinion has indeed shifted, Ms. Lardie said.
Maryland, too, is "ahead of the pack," she said. There, a political push for
universal health care is under way, though it involves no referendum this
year.
Oregon, as well, is a spot to watch. Campaigners there had planned a
referendum on a health care overhaul this season, they said, but postponed
it, in part because action is under way on the legislative front. Also, Gov.
John Kitzhaber of Oregon, a doctor, called for universal health care
insurance for all Oregonians earlier this year, saying he hoped to work out a
proposal for the 2001 Legislature.
In Massachusetts, other political avenues are being pursued. State Senator
Richard T. Moore, the Senate chairman of the Legislature's joint committee on
health care, said he was confident that legislators would pass their own
patients' bill of rights within the next month or so, one that would include
the possibility of external review for patients denied care by their managed
care providers. In addition, he said, a commission appointed by the governor
to examine health care financing, quality and safety is to begin meeting next
week.
He is concerned, Senator Moore said, that the ballot initiative "really goes
too far."
Dr. Harris A. Berman, the chief executive of Tufts Health Plan here, also
opposes the initiative, arguing that it can be expected to raise the price of
health care significantly by taking away H.M.O.s' ability to control costs.
To him, the very existence of the initiative, which tries to "use
oversimplification to solve a very complex problem," is counterproductive.
"In a health care system hurting as badly as Massachusetts'," Dr. Berman
said, "with every hospital and just about every health plan losing money and
home health care operations going out of business, to spend millions of
dollars that should be used on health care on this fight is just a travesty."
But campaigners say they will soldier on, regardless of criticism and
possible legislative action, convinced that universal health care would save
money by improving access to preventive care and thus avoiding expensive
emergency room visits. And, they said, it is also the morally correct path.
John Kenneth Galbraith, the economist, has lent his name to the campaign and
said he was supporting the initiative because he joined "with all sensible
people in not wanting to see anyone die because they can't afford the
requisite medical treatment."
He said he had grave doubts about whether health care "can be a business
enterprise, where one saves money by cutting back care."
Copyright 2000 The New York Times Company
(Editor's Note: Bulletin readers in Massachusetts who are circulating
petitions should get them in ASAP. MNA members should get them to David
Schildmeier at MNA headquarters in Canton if at all possible by the end of
this week, or mail them directly to the Coalition for Health Care at the
address imprinted on the petitions. To find out how to get involved in
efforts to drive corporate interests out of health care, go to
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