"It seems like no one is happy with this," said Gloth, a faculty member at the Johns Hopkins School of Medicine and director of outpatient services for the division of geriatric medicine and gerontology at Hopkins Bayview Medical Center in Baltimore. "Over here at Hopkins, I've got very liberal folks who think that things have gotten so watered down that it'll make no difference whatsoever and conservatives who are worried that things are still moving ahead."
Gloth, 53, spends the bulk of his time in private practice, dealing with elderly patients at long-term-care facilities as medical director of a chain of Maryland nursing homes and as a Manor Care contractor. He has started an electronic medical records company and is the author, most recently, of "Fit at Fifty and Beyond."
In an effort to sway local lawmakers, he has called in to telephone town hall meetings led by members of Congress, including Democratic Rep. John Sarbanes of Baltimore, and spoken at a number of forums organized by one of the leading opposition groups in the health care fight.
Gloth said the legislation being debated in Washington would mean more bureaucracy, higher costs and greater inefficiency - and would make matters "much worse" for doctors and patients.
"You don't want to misconstrue my negativity toward this bill as saying that nothing is better than doing something," he said in an interview at a Manor Care nursing home in Catonsville. "But it can't just be change for change's sake. It has to be improvement."
Gloth has become a favorite of Americans for Prosperity, a conservative, free-market group that has stimulated popular anger with its "tea party" protests and helped organize opposition to the Democratic overhaul plan last August at lawmakers' public meetings.
"He has done everything we've asked of him," Dave Schwartz, Maryland director of Americans for Prosperity, said of Gloth, who has been a featured speaker at the group's state and national events.
The soft-spoken physician from Finksburg in Carroll County isn't a newcomer to politics. He gives what sounds like an embarrassed laugh when reminded of his unsuccessful run for U.S. Senate in 1998, when he finished third in the Maryland Republican primary.
"As a physician, this is a scary time. I've dedicated my life to taking care of the most frail and vulnerable segment of our population in what I think is a challenging environment, and I worry that it will become insurmountable," said Gloth, who begins his day at 4 a.m. to help leave time for his wife and four daughters, ages 9 to 18.
He's suspicious of cost-saving provisions to let the federal government sort out ineffective or inefficient care, and he predicts that doctors will wind up bearing an unfair burden of changes in Medicare, the federal government health insurance program for those 65 and older.
Gloth favors alternative solutions for expanding insurance coverage and reining in costs, including health savings accounts tied to a version of the Federal Employee Health Benefits Program. However, a similar idea went nowhere under President George W. Bush, who couldn't get his savings-account initiative through a Republican-controlled Congress because of Democratic opposition.
Gloth acknowledges that he's far better off financially than most geriatricians, thanks to his various ventures, but he criticizes Medicare for effectively imposing "earning caps" on doctors.
"You can be the top doc in your area and you get paid the same, sometimes less, than a physician who just finished his fellowship or his residency," said Gloth, whose father, Fred M. Gloth Jr., was a top executive of what was then known as Blue Cross and Blue Shield of Maryland.
Pediatricians also rank, along with geriatricians, internists and family practitioners, near the bottom of the physician pay scale. They would qualify for payment bonuses of 5 percent or 10 percent for some types of services under the Democratic proposals, but that would do little to close the earnings gap with highly paid specialists.
Beams, who partners with her mother, Dr. Atiya Khan, in a practice that serves 4,000 children, says she makes less money than the average Howard County elementary school teacher.
In spite of her support for the Democratic plan, she worries that provisions to speed the transition to electronic health records "theoretically would put us out of business" because of the costs, estimated at $20,000 to $60,000 for a practice like hers. (By contrast, Gloth acknowledges that if the measure became law, in spite of his efforts, it could well be a boon for his Smart E-Records venture.)
"I'm here in the trenches with these sick children and sick families every day, seeing how the system's broken," said Beams, who traces her activist streak backto her time at the Park School in Baltimore and Swarthmore College in Pennsylvania, when the causes that drew her were human rights and the environment.