After Question 5: Lessons to be learned and applied 
By Ann Eldridge and Sandy Eaton

Many of us who are working to build support for the single payer financing legislation also worked on the YES on Question 5 campaign and have participated in a variety of other health care reform and advocacy efforts over the years. The single payer legislation, titled “The Massachusetts Health Care Trust” was initiated in the early 1990’s by the Massachusetts Campaign for Single Payer Health Care (Mass-Care), a coalition in which MNA is a member. Different years have brought different strategic activities and levels of intensity to our efforts. Although our approaches have not been static, we are united in our commitment to the broad goal of improving our health care system for those it serves and for those who work within it.

In recent years, responding to the urgency created by the ever-deepening crisis in health care, the resulting unmet needs of our patients and increasing financial waste of the current fragmented system, many nurses who are active supporters of the Mass-Care coalition and its related Universal Health Care Education Fund activities made a strategic decision to participate in the health care reform activities that led to Question 5 being on the statewide ballot. 

Along with other health care workers, patients and families, we felt a strategic decision was in order to take action directly to the people of Massachusetts in the form of a citizens ballot initiative. This was done with the force of law calling for specific fundamental reforms of the health care system. The abuses of managed care coupled with other aspects of the health care crisis (massive health funding cuts of the Balanced Budget Act of 1997, to name one), and little evident reason to be confident that legislative solutions were forthcoming contributed to the strategic decision to undertake a ballot initiative as a new tactic in health reform activities.

There are many lessons to be learned and skills to be honed by analyzing these ongoing collective efforts to improve the health care system. Doing so requires a conscious effort to pause from the hectic pace of our lives in order to think about what can be learned, and in turn what can be gained, through the three year process that started with the formation of the Ad Hoc Committee to Defend Health Care and grew into the YES on Question 5 campaign. The value of this type of reflective activity and critical thinking about our efforts cannot be underestimated. To be done well it calls for broad participation by all who have been involved in order to maximize our vast potential to be most effective in future advocacy endeavors. If you are able to carve out some time and the mental space to reflect on your involvement in these health care reform activities and are willing to share them, please email your thoughts to the Massachusetts Nurse in care of David Schildmeier at dschildmeier@mnarn.org for future publication on this topic. It will be much appreciated and benefit us all.

One area of ongoing creative tension and strategic discussions in both the state and national health care reform movements concerns the issue of how to build public and legislative support for single payer financing of health care. A strong consensus exists among health care reform advocates that single payer is a central mechanism for achieving a system that provides universal and cost effective access to care. Raising public and legislative awareness and understanding of the additional issues that contribute to cost-effective financing of quality health care, such as nurse staffing levels is also of paramount importance. Strategic thinking and planning about how to best work towards these goals, how to reach out and engage the public to join us, to learn from our ongoing efforts both here in Massachusetts and across the country has led to intense discussions and a heightened value of listening to and learning from each other. Continuing to build a strong and united peoples’ movement for fundamental health care reform is what will successfully overcome the well-funded insidious corporate tactics that are sure to be used against us.

Analyzing the final vote on Question 5, it is no coincidence that those regions such as the Berkshires, the Pioneer Valley and Cape Ann where the corporate-driven health care changes of the last decade have been the most traumatic are also those electoral districts that voted most strongly for Question 5. These same regions of the state also support single-payer fundamental reform the most. There are local coalitions in these regions, comprised of seniors, nurses, advocacy groups and others that have formed to speak out and take action against the corporate abuses of entire communities and individual patients. Wherever people have risen up united against the ravages of the current managed-care debacle and merger mania, the HMO/insurance industry lies embodied in the $7 million “No on 5” campaign had the weakest effect. These grassroots community insurgencies, like the wrath of organized nursing, have done the most to educate the broader public and lay the foundation for the coming revolution in health care in the Commonwealth. The lessons to be learned are plenty; now it is time to turn them into strategic action.