ow, let's get this straight. To kill Question 5, the state's managed-care industry is outspending a motley band of activists about 25 to 1, and counting. Yet recent polls show the supposedly earth-rattling initiative petition leading by a 2-to-1 ratio.
What's going on here? Money can't buy you love, that's what.
Last Saturday, Globe reporter Liz Kowalczyk sketched the outlines of the health maintenance organizations' plight. ''Middle class starts to feel HMOs pain,'' the headline said. She told of a man whose doctor of 40 years had dropped his HMO; of another facing a 44 percent jump in his HMO insurance premium (to a quarter of his income); and of a heart transplant recipient who may suffer as a result of the Partners HealthCare-Tufts Health Plan contract dispute.
From home health care and nursing homes to hospitals and HMOs, health care is in upheaval, stressed financially from top to bottom. The result is public fear and anxiety in this, the reputed medical mecca of the United States. The state's lethargic political environment this season isn't helping the No on 5 forces either, but there's more to it than that. Much more.
For one, the HMOs' television ads aren't lighting any fires. They may actually be counterproductive. To many voters, vexed by the managed care industry's inability to control costs, HMO arguments that Question 5 will create red tape and new government bureaucracies may sound like a good idea. In other words, if the HMOs can't fix it, let government take a shot.
''I think this is confusing for a lot of people,'' said Larry Rasky, consultant and co-manager of the No on 5 Coalition campaign. ''They see a lot of news in the paper about health care ... and most of it is bad. But this is not theoretical like a lot of ballot questions. This is real life. We're talking about people having to change their coverage systems.''
Question 5 is a sweeping, even radical proposition. It would mandate universal health coverage by July 2002, end managed care as we know it, require HMOs to spend at least 90 percent of budgets on direct patient care, and extend new decision-making freedom to both patients and health care professionals.
Many details, however, would be left to the Legislature and a new health care council.
Opponents say it will drive up costs by billions of dollars (though the figures are based on uncorroborated HMO claims that premiums will soar 26 percent to 60 percent), undo a ''patients' bill of rights'' enacted this year, and ''force many ... providers, plans, and hospitals out of business.''
If that's true, it seems odd that the Massachusetts Hospital Association is neutral on Question 5. Instead, the organization is focused on opposing Questions 4 and 6 - Governor Paul Cellucci's income tax rollback petition and a separate tax rebate plan for tolls and auto excise taxes. They pose a more immediate threat to the health care industry, said Judy Glasser, spokeswoman for the hospital group.
''The ballot question has spawned a serious debate about options to improve the system, and that's good,'' Glasser said. ''But we have concerns about the broad language of the question, and we're worried about some of the flexibility on caregivers.''
The Massachusetts Medical Society, which represents 17,000 physicians, opposes Question 5. Quietly. The society notified members but hasn't even issued a press release. Moreover, not a penny of the $3.1 million contributed as of Oct. 15 to the No on 5 Coalition is from a doctor or hospital.
''We very much support the objective of universal coverage,'' said Frank Fortin, spokesman for the society. ''But we fear the question would undo the managed care bill passed last summer, which we think was pretty great.''
No on 5 is primarily an HMO vehicle. Through Oct. 15, HMOs had given $2.8 million (Blue Cross and Blue Shield of Massachusetts led with $1.25 million) to stop Question 5. Corporations and the Massachusetts High Technology Council donated about another $300,000.
Against that, two separate committees had raised a paltry $127,000, not enough to buy ads and less than the No on 5 Coalition had spent on polling ($180,000). The HMOs spent $2.1 million on radio and TV ads, $475,000 for consultants ($300,000 to the California-based Winner/Wagner & Mandabach), and $155,000 on direct mail.
That's a lot of firepower against a pop gun. It may even turn the electorate around on Question 5 before the Nov. 7 election. But no matter what happens, this campaign proves that if you're an HMO in the year 2000, money can't buy you love.
