ne million dollars each week. That's what HMOs are spending to oppose Question 5 - the universal health-care ballot initiative - flooding the airwaves with confusing images and outright lies, ads ultimately paid for by patients' premiums.
Nothing. That's what it would cost to cover the uninsured and improve coverage for the rest of us - if we curtailed HMO bureaucracy, health care executives' outrageous incomes, and profiteering by drug and health insurance companies.
Two recent studies commissioned by the Massachusetts Medical Society, as well as an older one by Congress' Government Accounting Office, all concluded that a properly structured system of universal coverage would save money by cutting administrative costs. Every developed nation except the United States assures universal coverage, yet none spends even half as much (per capita) on health care as Massachusetts.
In response to the conclusive evidence that universal coverage is affordable, the HMO industry trumpets bogus claims that Question 5 would break the bank and increase bureaucracy. How ironic that HMOs, the chief purveyors of red tape, are smearing Question 5 with TV images of doctors drowning in the stuff.
HMO executives dislike Question 5 for obvious reasons. It would require them to spend at least 90 percent of premiums on actual care, sharply cutting their paperwork, profits, and personal incomes. It would free patients to choose any licensed doctor, loosening the HMOs' stranglehold over members' care. It would ban paying doctors to deny care. And it would block for-profit takeovers of HMOs and hospitals, and the eight figure payoffs that HMO executives in other states have gleaned from selling their plans to the highest bidder.
Governor Celluci and legislative leaders dislike Question 5 because it would force them to enact universal health-care coverage by July 1, 2001, and put teeth in HMO regulation. They prefer the deal they struck with industry insiders in July; limp regulations and promises to ''study'' universal coverage.
Unfortunately, while the Legislature has been fiddling, Massachusetts health care is aflame. This summer HMOs announced plans to drop thousands of seniors and demand double digit premium increases from their remaining customers. One of Boston's teaching hospitals - Beth Israel Deaconess - is slashing services and edging toward a for-profit sell-out.
Recently federal statisticians delivered two more pieces of bad news. First, our state has the highest health care costs in the world, 30 percent above the national average - despite having the nation's highest HMO enrollment. Second, the number of uninsured is actually rising in the Commonwealth, while the national numbers are inching down - 636,000 residents of Massachusetts, 10.5 percent of the population, have no health coverage according to the Census Bureau; 12 years ago only 368,000 were uninsured.
Our health-care system is failing. It is expensive, bureaucratic, and denies care to many who are in need. Question 5 rejects this status quo and mandates salutary reform.
Dr. Steffie Woolhandler and Dr. David Himmelstein are associate professors of medicine at Harvard Medical School and primary care doctors in Cambridge.
