As criticism mounts against HMOs and the number of uninsured continues to rise, a group of Maryland leaders called yesterday for sweeping health reform in the state.

The new group, called the Maryland Citizens' Health Initiative, released poll results revealing strong dissatisfaction with health maintenance organizations and a belief that the uninsured need health coverage.

"Our present health care system is an embarrassment," declared Dr. Alfred Sommer, dean of the Johns Hopkins School of Public Health. Of 27 developed countries, he said, only three don't guarantee every person health insurance -- Mexico, Turkey and the United States.

Putting such a comprehensive reform in place has been called impossible. Yet even in the face of stalled reform in Congress, public fears and industry pressures, this group is betting that Maryland is the place, and the time is soon.

The group's president, Dr. Peter L. Beilenson, who is also the Baltimore City health commissioner, said the organization would work for a plan that guarantees "freedom of choice of doctors and other providers," assures "insurance companies do not come between the doctor and the patient," and asserts that "health care for all is a right, and it should not be based on income or employment."

The Citizens' Health Initiative did not provide a specific plan to fix Maryland's health system and doesn't plan to do so any time soon.

"This is clearly a work in progress," said the group's executive director, Vincent DeMarco, who built similar coalitions around gun control and youth smoking issues. "Before somebody can take this to the legislature, there has to be a public discussion of the issue. Hopefully, over the next two or three years, a consensus will develop."

Maryland has a history of pioneering innovative approaches in health care, and national experts said that will help as doctors, patients, ministers and labor leaders wrestle with one of the most complex problems facing the country.

"It's difficult to do anything comprehensively at the state level, when we have such an overwhelming problem nationally," said Diane Rowland, executive director of Kaiser Commission on Medicaid and the Uninsured, an independent policy institute. "But if any state is going to try it and has a chance of succeeding, it's certainly Maryland."

Over the years, bills have been introduced in Congress and in dozens of state legislatures calling for all people to be covered, often under a single-payer plan similar to Canada's system, in which the government pays all health costs. But the ideas have met strong resistance from insurance companies, who would be cut out, as well as a skeptical public.

The need to improve the country's health care system is again gaining national attention, experts believe. Despite the nation's booming economy, about 1 million Americans are added to the rolls of the nation's 43 million uninsured every year. About 750,000 Marylanders don't have insurance and about the same number are underinsured, Beilenson said. At the same time, health costs are growing, and patients are complaining about HMO barriers to care.

"It's definitely an issue that is more on the table than it has been in a long time," said Judy Waxman, director of government affairs for Families USA, a national advocacy group. "Some states are moving ahead on their own, and I think you're going to start hearing more about it on the federal level."

In Massachusetts, a group pushing for a statewide single-payer plan has won the support of nearly half the state Senate and a third of the state House, said Dick Mason, chairman of the Massachusetts Campaign for Single Payer Health Care, or Mass-Care.

"They're seeing all these problems coming across their desks . . . and more and more realizing that they're not going to address this problem piecemeal. They've tried that for 10 years, and it's not working," Mason said. "There can be sea changes in policy. Who could have predicted in 1988 that the Soviet Union would fall apart?"

Change of focus

In Maryland, reform efforts in recent legislative sessions have included controlling the cost and coverage of insurance purchased by small employers, adding coverage for uninsured children, and protecting access under HMOs to emergency care. But the focus has been on improving and extending the current system, not replacing it.

In addition to Hopkins' Sommer, the Maryland initiative won support yesterday from Dr. Wayne Spiggle, president of MedChi, the state medical society; the Rev. Douglas I. Miles, president of the Interdenominational Ministerial Alliance, a coalition of 200 African-American churches; and Ernest Crofoot, representing the state AFL-CIO.

The initiative received initial funding of $150,000 from the Kellogg Foundation and $100,000 from the Abell Foundation.

Part of that money went to conduct the poll. Penn, Schoen & Berland of Washington interviewed 1,526 Marylanders, finding considerable dissatisfaction with the current health system and fear that things could get worse.

'Bad for people's health'

The poll shows "what doctors have been saying for some time -- that the insurance industry, as constructed, is bad for people's health," Spiggle said.

Among the poll results:

78 percent agreed that "every Maryland resident should be entitled to comprehensive health coverage, whether they have a job or not."

35 percent said their insurer had refused to pay for all or part of care they thought they needed.

89 percent agreed that "managed care companies are making health care decisions that should only be made by doctors and their patients."

In spite of criticisms of HMOs in general and fears about the future, 85 percent said they were very satisfied or somewhat satisfied with their current health coverage.

DeMarco said Beilenson had been having informal conversations around the state about health reform for some time, which led to a decision to form an organization and hire a staff. DeMarco, former director of Marylanders Against Handgun Abuse and the Maryland Children's Initiative, an anti-smoking group, came on board this spring. So far, he is the only employee.

He said he plans to reach out to community, religious and labor groups to reach a consensus for reform, building toward the statewide elections in 2002.