Massachusetts voters will decide Nov. 7 on a ballot initiative that would provide universal healthcare for all residents, ban for-profit healthcare and disassemble the state's HMOs.
It's a prospect that excites supporters and terrifies opponents. It's the only such measure on the ballot across the country, according to the National Conference of State Legislatures.
If adopted, Question 5 would not only create universal coverage but also would allow patients to seek care from any doctor, ban the conversion of not-for-profits to for-profits and strictly control HMOs.
Polls show Massachusetts residents support the proposal, although by how much varies from survey to survey. A poll in late September found that 72% supported the ballot measure while 17% opposed it.
Lined up in favor are those who say administrative costs are out of control, that the number of uninsured is unacceptable and that the system must be overhauled to salvage it. At its peak, the coalition of supporters has had only a few thousand dollars to get its message out.
"Everyone in the system agrees that the system is far from efficient and effective," says John Goodson, M.D., an internist, associate professor of medicine at Harvard University and a backer of the proposal. He adds that Question 5 would not create a single payer system. And he says that the initiative isn't meant to be the only answer to the healthcare crisis. "This is a process. It's not a recipe . . . This would begin a process to define certain key parameters."
The opposition is led by the state's health plans, which find themselves strangely allied with physicians, unions and employers. Initially, some physicians supported or were neutral toward the plan. But when a managed care reform bill was signed into law in July, many of the supporters switched sides, convinced Question 5 would dismantle what was seen as a comprehensive healthcare reform law.
Some portions of the managed care law went into effect immediately. The remainder become effective Jan. 1.
Opponents have dug into deep pockets to defeat the proposition. Blue Cross Blue Shield of Massachusetts donated $255,000, and Harvard Pilgrim Health Care, which was nearly bankrupt earlier this year, has donated $100,000 to the coalition to defeat the initiative.
"The quality of healthcare could suffer significantly," says Stephen Allen, spokesperson for the No on 5 Coalition. "The provisions in this bill would allow any licensed healthcare provider--aromatherapists, acupunturists--to prescribe tests and potential treatment. Right now, Massachusetts' healthcare system . . . is based on scientific knowledge."
Question 5 would limit administrative costs to 10% of overall expenditures, Allen says. That provision would effectively eliminate community-based clinics and hinder plans' ability to purchase computers and provide other services, he says.
One of Question 5's provisions to ban conversion of not-for-profit entities to for-profit would seriously damage rural hospitals, Allen says.
Frank Fortin, spokesperson for the Massachusetts Medical Society, says the managed care law needs time to work.
"If the ballot initiative were to pass, we'd be back at square one," he says.
That simply isn't true, Goodson says. The majority of the managed care reform act passed in July would be unaffected. The irony, he says, is that the reform act wouldn't have passed if Question 5 were not on the ballot.
"Unless we change things, things are going to get worse," Goodson says. "It's really a chance for the voters of this state to get together and redesign the administration of the healthcare system."