Health-care reform 101, continued

by Tinker Ready

Williams, an active member of the AMSA, signed up for the program as both a coordinator and a participant. "I really didn't know what to expect," says the poised, soft-spoken 24-year-old, who is entering her second year at Meharry Medical College in Nashville. "I got off the plane and within an hour was whisked off to a Coalition [for Health Care] meeting."

She spent June working out of the Ad Hoc Committee's office: setting up lectures, finding housing for participants, and figuring out how to plug them into the campaign. A first group of about 10 students was scheduled to arrive in mid July for 10 days. A second group was scheduled for late July.

Meanwhile, there was talk of a compromise on Beacon Hill. The HMO industry was reportedly getting a bit nervous about the ballot question, and word came down that if the Coalition for Health Care would drop the ballot initiative, the delayed patients'-rights legislation would pass.

Many of the coalition members were interested, but the Ad Hoc Committee wasn't. When the legislature failed to act before the deadline for filing petitions to put a question on the ballot, if seemed as though the debate had been settled. On July 5, Williams watched as coalition leaders strapped their petitions to a gurney, climbed into an ambulance parked outside the State House, and drove off to file the petition signatures.

Twenty minutes later, Williams was on a Red Line train with Ad Hoc Committee director Timothy McCall when his cell phone rang. The legislature had come up with a compromise and the coalition staff needed to know what the members thought. That night, the Ad Hoc Committee held an emergency meeting and rejected the plan.

Some components were what they wanted. For example, the compromise "bill of rights" law mandates that insurance companies pay for "reasonable" drugs, surgery, or treatment ordered by a doctor. (Currently, HMOs and other insurers will refuse to pay for services they decide are "unnecessary," even if the patient's doctor disagrees.) And if HMOs deny payment, patients will be able to appeal the decision to an outside panel. The bill also improves access to specialists and emergency-room services. The Coalition for Health Care officially declared that the measures are "the most comprehensive and important health reforms since the 1980s."

To Himmelstein, McCall, and the rest of the Ad Hoc Committee, this wasn't enough. "To say we're going to give up universal access for some ineffective patient protections -- that was never even discussed," Himmelstein says.

But as the rest of the coalition members called in their votes to headquarters, the Ad Hoc Committee found itself outnumbered. The Coalition for Health Care as a whole voted to support the compromise.

Whether this represents a battle won or a battle lost depends on which member of the coalition you talk to. But either way, the deal meant that the larger coalition, with its money and resources, was no longer behind the ballot question. It also meant that a crucial part of the med students' summer program was over before it started. Williams called the students and told them there might not be a campaign, and several canceled. "The students were hoping to get out there, get in the trenches, drop leaflets, and really be involved in the campaign," she says.

In the end, only three other students attended. They spent their week listening to activists, attending sessions like "Health Reform 101" and "The Nuts and Bolts of Organizing." The nuts and bolts were taught by John O'Connor, a wealthy Cambridge businessman (and 1998 congressional candidate) who helped bankroll the Coalition for Health Care and broker the compromise. Without mentioning the specifics of the campaign, O'Connor told the four students gathered in his East Cambridge office that they should set realistic goals if they want to succeed as organizers.

"Universal health care -- it's a multi-year battle," he said. "If you set your goal as `I'm not going to feel successful unless everyone is covered within six months,' you're setting yourself up for failure."

The issue, however, is not finished. Even without coalition support, the universal-care question is still on the ballot. There was talk of removing it, but once the signatures had been filed, that maneuver was legally impossible. This fall, Massachusetts voters can still vote for universal health care.

And there will be a campaign to pass it, albeit a quiet one. In late July, members of the Ad Hoc Committee decided to break off from the larger coalition and form a new organization to push for a "yes" vote. Without much funding, that will probably materialize as a door-to-door, word-of-mouth campaign -- and it likely will be a lopsided fight. Opposing the initiative is a multimillion-dollar campaign by a group of insurers and business interests calling themselves the Committee for Affordable Health Care Choices.

So voters can expect a series of television ads telling them that passing the ballot question would raise premiums. Far fewer voters will hear from campaigners who will argue that the initiative would force the state to deal with the problem of the uninsured.

The day after Governor Paul Cellucci signed the patients'-rights bill into law, Makeba Williams was scheduled to head back to Alabama to get ready for school. There, she says, most of her colleagues are so overwhelmed by their studies that they don't think much about how medicine is changing.

"All of this is going to affect the way we practice," she says. "Ignorance is going to be debilitating."

Undaunted by the political wrangling she has just been through, Williams says she plans keep working to educate her fellow medical students about managed care, the uninsured, and health-care reform. Indeed, Williams's two months in Boston taught her a lot about health care and politics. "This has been such an education," she said after the session with O'Connor, and rolled her eyes.

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Tinker Ready is a freelance writer based in Cambridge. She can be reached at tinkerr@mediaone.net.