A healthy opportunity

By Adrian Walker, Boston Globe Columnist , May 13, 2004

Khalil Landers is a man pursuing a dream.

An aspiring emergency medical technician, he works for the city on the mayor's Health Van. A sort of clinic on wheels, it travels the city screening patients' cholesterol and blood sugar levels.

A temporary employee who expects his job to end in June, Landers holds an ironic distinction. Though training for a career in health care, he does not himself have health insurance.

He has plenty of company in Massachusetts. Of the 600,000 adults without insurance, an estimated 275,000 of them hold jobs.

“When I applied for MassHealth I was rejected because it wasn't accepting new members," he said yesterday. "With the lack of insurance, it's been my experience that you don't always get what you need.”

Help, perhaps, is on the way. A constitutional amendment to extend health insurance to the uninsured has garnered 81,000 signatures and could come to a vote by legislators next month. If it passes, that would put it on the road to appearing on the ballot in 2006, though its fate is unclear.

This is not merely a Massachusetts issue. A report recently released by the Robert Wood Johnson Foundation estimated that 44 million Americans don't have insurance; $41 billion will be spent this year on uncompensated care for the uninsured, straining health centers and emergency rooms already brimming with patients. The study suggests that the uninsured can expect to receive about half the health care received by people with insurance. It's a public policy nightmare, and it shows no signs of improving.

Covering the uninsured is a policy initiative that easily gets lost in a thicket of issues with greater emotional appeal. It lacks a powerful constituency and tends not to mobilize activists. Call it a cold-button issue.

Former state representative John McDonough, who was long the Legislature's acknowledged expert on health care, believes this is a time when that could change. He points to announcements that state revenues are rising and a new Medicaid surplus as evidence that the state's fiscal crisis, which has strangled nearly every new initiative of recent years, may be over.

“As opposed to 2002 and 2003, where every month and every quarter the estimates of revenues were [below] projections, now they're up," said McDonough, who is executive director of Health Care for All, an advocacy group that supports the pending amendment on insurance. "The state's fiscal situation tends to lag behind the economy, but it's looking increasingly positive and strong. ”

He has some ideas for how to spend growing revenues, once Beacon Hill begins to see the money.

“Step one right now would be repairing the damage that has been done over the past several years to important programs that have been cut,” said McDonough. “There's been a major erosion in the health care safety net for children. The first step is pushing to repair the damage that has been done to children's programs and to restore coverage.”

McDonough believes the combination of a strong economy and the political will needed for a bigger public commitment to health care comes along only occasionally. There was a major expansion in the late 1980s and another in the fiscally flush period of 1997-1998. Since then, most of the movement has been backward. If he's right, thinking two to three years down the road makes sense.

As for Landers, his current EMT course ends in June, right around the time that his job probably will. But he would be eligible to take the state exam in July and looks forward to the prospect of a permanent job -- and better access to health care -- sometime this fall. He has some minor ailments he'd like to address.

“If I had insurance, some of the things I'd like to do, I can get done,” he said.

Adrian Walker is a Globe columnist. He can be reached at walker@globe.com.

© Copyright 2004 The New York Times Company.

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