BOSTON, Mass. - They were five physicians who were convinced that the health care system had veered dangerously off course, that profits, instead of patients, were at its core. Every one had stories of patients floundering in the bureaucratic sea of managed care. All believed the marketplace had seriously compromised their ethics.
Together, they issued a "call to action" with nonnegotiable terms - a patient's right to choose his physician, a moratorium on takeovers of health-care institutions by for-profit companies and health care for all.
To dramatize their cause, they commandeered the replica of the Boston Tea Party ship and tossed from its decks crates stamped with their message, "For Patients, Not For Profits."
`Call to action' manifesto
Their "call to action" manifesto - co-signed by 3,300 physicians and nurses - served as the basis of a wide-ranging, health care reform initiative now on the November ballot here and unique in the country. But along the way, political realities and professional agendas intervened.
And, on Election Day, a contest once viewed as a public barometer on the state of health care is now expected to turn on advertising dollars.
Big business, including Aetna US Healthcare and two leading health-maintenance organizations in the state, has contributed $1.1 million to defeat the ballot question and has hired a California consultant with a reputation for turning out a negative vote.
The proponents of ballot Question Five have about $4,000 to spend. They lost their ability to raise big money and draw thousands of volunteers when the biggest health care workers union and a patient advocacy group deserted them for a legislative compromise.
"What's going on in Massachusetts is symbolic of how powerful the health care issue is all around the country," said Vincent DeMarco, executive director of the Maryland Citizens Health Initiative, a reform group targeting the 2002 elections. "Clearly, there are powerful vested interests who oppose health care for all. But my experience is that powerful vested interests like guns and tobacco fall before grass-roots initiatives led by religious, labor and community health care organizations."
Unlike Maryland's effort, which began as a statewide coalition of churches, labor unions and community groups, the Massachusetts initiative started with five doctors concerned that their profession had become increasingly commercialized and their relationship with patients irrevocably compromised.
They were a Nobel Peace Prize winner, a couple that exposed the financial perks of health care executives, the daughter of a school nurse and the author of a book on the student protest movement at Columbia University.
They wrote a "call to action" on the state of American health care, which appeared in a December 1997 issue of the Journal of the American Medical Association. The group, known as the Ad Hoc Committee to Defend Health Care, wanted to initiate a public debate on the state of health care.
They kicked it off at a Boston landmark, Faneueil Hall, and featured Harvard luminary John Kenneth Galbraith and lampooned the business of health care to the music of Pink Floyd.
The Ad Hoc committee members eventually decided to petition the issue onto the November ballot. Their cause united the Massachusetts Nurses Association, the Service Employees International Union (Local 285), the League of Women Voters, Massachusetts Senior Action, Health Care for All, a patient advocacy group, and others in a ballot drive that collected more than 110,000 signatures from Pittsfield to Provincetown.
Petitions on a stretcher
On the day this summer that the signatures were due, the triumphant doctors arrived at the secretary of state's office in an ambulance and delivered the petitions on a stretcher.
"I don't think they [the health-care establishment] thought we could pull it off," said Dr. Susan Bennett, an internal medicine specialist and founding member of the Ad Hoc group. "They just thought we were high-minded academics with pie-in-the-sky ideas. They were wrong."
But the doctors' four-year fight to transform health care delivery in Massachusetts became a victim of its own success. State lawmakers and the health care establishment recognized the seriousness of the forces behind the initiative.
A compromise was sought. When legislators agreed to pass a law to codify patient rights, regulate HMOs and study the prospect of insuring all Massachusetts residents, a majority of the 9-member ballot coalition signed on and dropped their support of the initiative. But the Ad Hoc committee, the practitioner-led group, refused to give up.
"Each step of the way has been a cliffhanger as it is at this very moment," said Dr. Jerry Avorn, a Harvard medical school professor and co-founder of the group.