| o kill it. | | | | Gloth said the legislation being debated in Washington |
| "Lobbyist" is not a title these Baltimore-area doctors | | | | would mean more bureaucracy, higher costs and |
| would give themselves, but Gloth and Beams are | | | | greater inefficiency - and would make matters "much |
| advocates in the biggest lobbying fight of the decade: | | | | worse" for doctors and patients. |
| the overhaul of America's health care system. | | | | "You don't want to misconstrue my negativity toward |
| Members of Congress shaping a final legislative | | | | this bill as saying that nothing is better than doing |
| product have been responsive to efforts by members | | | | something," he said in an interview at a Manor Care |
| of the medical profession, who have been deeply | | | | nursing home in Catonsville. "But it can't just be change |
| involved for months. Just the other day, an aggressive | | | | for change's sake. It has to be improvement." |
| lobbying campaign by physicians and hospital | | | | Gloth has become a favorite of Americans for |
| executives was credited with blocking a key element | | | | Prosperity, a conservative, free-market group that has |
| of the Senate health care measure, a proposal that | | | | stimulated popular anger with its "tea party" protests |
| would have let Americans between the ages of 55 | | | | and helped organize opposition to the Democratic |
| and 65 buy into the Medicare program. | | | | overhaul plan last August at lawmakers' public |
| A Christmas Eve vote on the Senate's overhaul plan is | | | | meetings. |
| now in sight. If, as expected, the Democrats prevail, a | | | | "He has done everything we've asked of him," Dave |
| House-Senate conference committee would have to | | | | Schwartz, Maryland director of Americans for |
| reconcile the differing plans of the two chambers, | | | | Prosperity, said of Gloth, who has been a featured |
| which would then have to each ratify the compromise. | | | | speaker at the group's state and national events. |
| The legislative deal-making will be heavily influenced by | | | | The soft-spoken physician from Finksburg in Carroll |
| months of closed-door meetings among lawmakers or | | | | County isn't a newcomer to politics. He gives what |
| their staffs and the legion of traditional Washington | | | | sounds like an embarrassed laugh when reminded of |
| lobbyists who are well paid to advance their clients' | | | | his unsuccessful run for U.S. Senate in 1998, when he |
| interests. | | | | finished third in the Maryland Republican primary. |
| AARP, for example, is widely credited with helping to | | | | "As a physician, this is a scary time. I've dedicated my |
| persuade lawmakers to add a provision that would | | | | life to taking care of the most frail and vulnerable |
| close the "doughnut hole" in Medicare drug plans, at an | | | | segment of our population in what I think is a |
| estimated cost of at least $20 billion, which some | | | | challenging environment, and I worry that it will become |
| Democrats expect the drug industry to pick up. | | | | insurmountable," said Gloth, who begins his day at 4 |
| But one of AARP's top lobbyists, Nancy LeaMond, has | | | | a.m. to help leave time for his wife and four daughters, |
| said that the most influential advocates in this year's | | | | ages 9 to 18. |
| health care struggle are those who have brought | | | | He's suspicious of cost-saving provisions to let the |
| organizational tactics from political campaigns into the | | | | federal government sort out ineffective or inefficient |
| health care debate. | | | | care, and he predicts that doctors will wind up bearing |
| For instance, conservative opponents of the | | | | an unfair burden of changes in Medicare, the federal |
| Democratic initiative were successful in stoking a "kind | | | | government health insurance program for those 65 |
| of wildfire," she said, "over anything that involves the | | | | and older. |
| government." A well-known example: the furor over | | | | Gloth favors alternative solutions for expanding |
| end-of-life issues, fed by false rumors of government | | | | insurance coverage and reining in costs, including health |
| "death panels," which rattled members of Congress at | | | | savings accounts tied to a version of the Federal |
| their town hall meetings in August. | | | | Employee Health Benefits Program. However, a similar |
| Gloth and Beams differ sharply over how best to fix a | | | | idea went nowhere under President George W. Bush, |
| system that each sees as badly broken. Perhaps | | | | who couldn't get his savings-account initiative through a |
| surprisingly, given their opposing views, they have more | | | | Republican-controlled Congress because of |
| than a little in common. | | | | Democratic opposition. |
| Idealistic and hard-working, they grew up in local | | | | Gloth acknowledges that he's far better off financially |
| households tied to the business of medicine. Somehow, | | | | than most geriatricians, thanks to his various ventures, |
| each finds time to fit political activism into a busy life as | | | | but he criticizes Medicare for effectively imposing |
| a full-time doctor and parent of young children. | | | | "earning caps" on doctors. |
| Beams, 37, a pediatrician from Ellicott City, is trying to | | | | "You can be the top doc in your area and you get |
| mobilize practicing physicians - individuals not normally | | | | paid the same, sometimes less, than a physician who |
| given to political activism - around issues such as | | | | just finished his fellowship or his residency," said Gloth, |
| changing the way doctors are paid. | | | | whose father, Fred M. Gloth Jr., was a top executive |
| "Obviously, I get to solve small problems here every | | | | of what was then known as Blue Cross and Blue |
| day," she said in an interview at her Columbia office. | | | | Shield of Maryland. |
| "But I've always been interested in the bigger picture | | | | Pediatricians also rank, along with geriatricians, internists |
| as well." | | | | and family practitioners, near the bottom of the |
| Last winter, she joined Doctors for America, an | | | | physician pay scale. They would qualify for payment |
| outgrowth of a physicians group from Barack | | | | bonuses of 5 percent or 10 percent for some types of |
| Obama's presidential campaign. She e-mailed her | | | | services under the Democratic proposals, but that |
| personal contact list, asking physician friends to sign an | | | | would do little to close the earnings gap with highly paid |
| online petition that was designed to draw them into the | | | | specialists. |
| political process. When more than 1,000 replies came | | | | Beams, who partners with her mother, Dr. Atiya Khan, |
| back within 36 hours, the group gave her a leadership | | | | in a practice that serves 4,000 children, says she |
| position. She's now organizing doctors in Maryland and | | | | makes less money than the average Howard County |
| eight other states as a deputy field director. | | | | elementary school teacher. |
| "Legislators want to hear from us, and their staff want | | | | In spite of her support for the Democratic plan, she |
| to hear from us," she said. "As physicians, we have an | | | | worries that provisions to speed the transition to |
| area of expertise and a sort of moral authority, and it's | | | | electronic health records "theoretically would put us out |
| important to raise that voice in the political process." | | | | of business" because of the costs, estimated at |
| She has led efforts to prod doctors and medical | | | | $20,000 to $60,000 for a practice like hers. (By |
| students into contacting lawmakers by mail, phone or in | | | | contrast, Gloth acknowledges that if the measure |
| person, and she has gone door to door in her office | | | | became law, in spite of his efforts, it could well be a |
| complex and at the hospital to promote the | | | | boon for his Smart E-Records venture.) |
| Democratic plan. She took part in a Rose Garden | | | | "I'm here in the trenches with these sick children and |
| event with Obama, was featured on PBS' "News | | | | sick families every day, seeing how the system's |
| Hour" and on MSNBC, and appeared in a video on the | | | | broken," said Beams, who traces her activist streak |
| White House Web site. | | | | backto her time at the Park School in Baltimore and |
| Still, Beams said, she cringed when a close friend from | | | | Swarthmore College in Pennsylvania, when the causes |
| college phoned and said, " 'Thank you for all your | | | | that drew her were human rights and the environment. |
| lobbying on behalf of health care reform.' And I said, 'I'm | | | | She remains an active supporter of Obama's plan, |
| not a lobbyist!' " | | | | even after the president effectively abandoned a |
| A wife and mother of four children younger than 10 | | | | provision that has been a key for her - a |
| years old, she rises most days between 6 a.m. and | | | | government-run insurance option that would compete |
| 6:30 a.m. "Sometimes," the doctor said with a laugh, "I'm | | | | with private insurers and make health coverage more |
| up at 3 in the morning." | | | | affordable for the working-class families she treats. |
| Like Beams, whom he has never met, Gloth has been | | | | Beams worries that many of her patients won't be |
| pushing his private ideas in the public arena. The goal: | | | | able to afford required medical insurance, even with |
| to influence Congress by changing public opinion. | | | | government subsidies. |
| Recent national polling has found that a plurality of | | | | She defends the efforts of activists like herself in |
| Americans now oppose the plan being debated in | | | | pressuring Congress to act, even after the |
| Washington. But Gloth, who strongly opposes the | | | | compromises that have weakened the measure |
| legislation, takes issue with the notion that his side is | | | | beyond repair in the eyes of some liberals. |
| winning. | | | | It "could have died in August," she said, when |
| "It seems like no one is happy with this," said Gloth, a | | | | opponents staged their noisy protests. |
| faculty member at the Johns Hopkins School of | | | | "The legislation does a lot of good things," she said, |
| Medicine and director of outpatient services for the | | | | such as preventing insurers from taking away |
| division of geriatric medicine and gerontology at | | | | coverage or refusing to provide it in the first place |
| Hopkins Bayview Medical Center in Baltimore. "Over | | | | because of a pre-existing medical condition, and |
| here at Hopkins, I've got very liberal folks who think | | | | allowing parents to retain medical coverage for their |
| that things have gotten so watered down that it'll | | | | children up to age 26. "Some change is better than no |
| make no difference whatsoever and conservatives | | | | change. It probably behooves us progressives to get |
| who are worried that things are still moving ahead." | | | | behind the bill." |
| Gloth, 53, spends the bulk of his time in private practice, | | | | With Senate Democrats about to approve a sweeping |
| dealing with elderly patients at long-term-care facilities | | | | overhaul measure in spite of unanimous opposition |
| as medical director of a chain of Maryland nursing | | | | from Senate Republicans and widespread public |
| homes and as a Manor Care contractor. He has | | | | doubts, Beams said she doesn't view it as a victory |
| started an electronic medical records company and is | | | | for her side. |
| the author, most recently, of "Fit at Fifty and Beyond." | | | | "I see it as being about patients and working |
| In an effort to sway local lawmakers, he has called in | | | | Americans all over the country who deserve a better |
| to telephone town hall meetings led by members of | | | | health care delivery system and deserve better health |
| Congress, including Democratic Rep. John Sarbanes of | | | | security," she said. "I see it as something we need to |
| Baltimore, and spoken at a number of forums | | | | do as a nation, for our people's well-being and the |
| organized by one of the leading opposition groups in | | | | economy's stability. It's not about Democrats and |
| the health care fight. | | | | Republicans or our side versus their side. |