Health-care reform 101
Med students get an unexpected clinic in real-world politics
by Tinker Ready
When medical student Makeba Williams arrived in Boston from Alabama two months
ago, she expected to spend the summer organizing and attending a hands-on
workshop on how to take health-care reform to the streets.
Makeba Williams came to Boston to campaign for a ballot question that would
have guaranteed health care to everyone in Massachusetts. When the coalition
backing the initiative cut a deal with state legislators, universal care was
left behind -- and Williams learned that competing interests can quickly turn
allies into adversaries.
Instead, she got a quick lesson in back-room politics.
She came at the invitation of the Ad Hoc Committee To Defend Health Care, a
doctors' group pushing a ballot question that would guarantee health care for
every resident of Massachusetts. Their idea was to train a group of med
students in both health policy and political organizing -- two topics they
don't cover in medical school. The students would attend an activist boot camp
and then hit the streets in support of the ballot question.
By the time the students arrived, however, the ballot campaign was all but
over, months before the election. The Coalition for Health Care -- a larger
umbrella group that had collected the 100,000 signatures necessary to put the
question on the ballot -- had cut a deal with its allies in the state
legislature and withdrawn support for the initiative. In exchange, the
coalition won passage of a stalled bill that would give patients more muscle in
dealing with their HMOs. With this weaker legislation passed, the ballot
question calling for universal health care became essentially an orphan.
So Makeba Williams learned a somewhat different lesson than the one she came
for. Among other things, she saw how competing interests in the health-care
debate can turn allies into adversaries. Williams also learned firsthand how
the need for a quick resolution can trample a careful decision-making process.
The final deal was brokered over the phone, overnight, with little face-to-face
"I'm all for compromise," Williams says. "I just think the process would have
been better if we were able to sit down at the table and say `I like this
piece' and `I don't like this piece.' But they say that's the way the game of
This summer's health-care-reform battle shaped up as a classic case of
revolutionaries versus reformers.
In the revolutionary corner was David Himmelstein, 50, a tall, ponytailed
internist at Cambridge Hospital and a founding member of the Ad Hoc Committee.
He and his wife, fellow doctor Steffie Woolhandler, look like a couple of aging
hippies, but they're nationally known in health-policy circles for their
intense commitment to radical reform.
Jointly known as the "Himmelhandlers," they regularly publish well-received
papers on the shortcomings of for-profit health care and the benefits of
Canada's government-run insurance program.
Four years ago, they helped found the Ad Hoc Committee, which is made up of
doctors, nurses, and other health-care workers tired of insurance companies'
second-guessing their medical decisions. They've held rallies, they published a
manifesto in the Journal of the American Medical Association, and they
tossed HMO contracts into Boston Harbor. Recognizing the widespread frustration
with the increasingly complex health-care bureaucracy, the committee decided to
take its case directly to the Massachusetts public, in the form of a ballot
question. Working with veteran activist Jim Braude (now a Cambridge city
councilor), the group wrote an initiative that would guarantee health insurance
for everyone in the state. Then they added a provision that would create a
"patients' bill of rights," a term used to describe a growing number of laws
that give patients the legal right to appeal HMO decisions.
But the relatively small and politically inexperienced Ad Hoc Committee didn't
have the money, manpower, or political know-how to collect the 100,000
signatures needed to get on the ballot. So they looked around for partners and
found, among others, several local unions, the state AFL-CIO, a consumer group
known as Health Care for All, and the League of Women Voters. Several of these
groups had already been pushing their own patients'-bill-of-rights law on
Beacon Hill, but the legislation seemed hopelessly stalled in committee. So
they joined with the Ad Hoc Committee to form the Coalition for Health Care.
At the same time, the Ad Hoc Committee -- along with the American Medical
Students Association (AMSA) -- decided to organize the anthemic-sounding
"Massachusetts Summer 2000," a program modeled after the 1964 Freedom Summer.
Instead of sending college students south to work for civil rights, the
Massachusetts program was designed to bring medical students here to work on
the Ad Hoc Committee's campaign. This is what brought Makeba Williams to
Tinker Ready is a freelance writer based in Cambridge. She can be reached at