Dr. Zaneb Beams is doing everything she can to get Congress to approve health care legislation. Dr. F. Michael Gloth III is trying just as hard to kill it.

"Lobbyist" is not a title these Baltimore-area doctors would give themselves, but Gloth and Beams are advocates in the biggest lobbying fight of the decade: the overhaul of America's health care system.

Members of Congress shaping a final legislative product have been responsive to efforts by members of the medical profession, who have been deeply involved for months. Just the other day, an aggressive lobbying campaign by physicians and hospital executives was credited with blocking a key element of the Senate health care measure, a proposal that would have let Americans between the ages of 55 and 65 buy into the Medicare program.

A Christmas Eve vote on the Senate's overhaul plan is now in sight. If, as expected, the Democrats prevail, a House-Senate conference committee would have to reconcile the differing plans of the two chambers, which would then have to each ratify the compromise.

The legislative deal-making will be heavily influenced by months of closed-door meetings among lawmakers or their staffs and the legion of traditional Washington lobbyists who are well paid to advance their clients' interests.

AARP, for example, is widely credited with helping to persuade lawmakers to add a provision that would close the "doughnut hole" in Medicare drug plans, at an estimated cost of at least $20 billion, which some Democrats expect the drug industry to pick up.

But one of AARP's top lobbyists, Nancy LeaMond, has said that the most influential advocates in this year's health care struggle are those who have brought organizational tactics from political campaigns into the health care debate.

For instance, conservative opponents of the Democratic initiative were successful in stoking a "kind of wildfire," she said, "over anything that involves the government." A well-known example: the furor over end-of-life issues, fed by false rumors of government "death panels," which rattled members of Congress at their town hall meetings in August.

Gloth and Beams differ sharply over how best to fix a system that each sees as badly broken. Perhaps surprisingly, given their opposing views, they have more than a little in common.

Idealistic and hard-working, they grew up in local households tied to the business of medicine. Somehow, each finds time to fit political activism into a busy life as a full-time doctor and parent of young children.

Beams, 37, a pediatrician from Ellicott City, is trying to mobilize practicing physicians - individuals not normally given to political activism - around issues such as changing the way doctors are paid.

"Obviously, I get to solve small problems here every day," she said in an interview at her Columbia office. "But I've always been interested in the bigger picture as well."

Last winter, she joined Doctors for America, an outgrowth of a physicians group from Barack Obama's presidential campaign. She e-mailed her personal contact list, asking physician friends to sign an online petition that was designed to draw them into the political process. When more than 1,000 replies came back within 36 hours, the group gave her a leadership position. She's now organizing doctors in Maryland and eight other states as a deputy field director.

"Legislators want to hear from us, and their staff want to hear from us," she said. "As physicians, we have an area of expertise and a sort of moral authority, and it's important to raise that voice in the political process."

She has led efforts to prod doctors and medical students into contacting lawmakers by mail, phone or in person, and she has gone door to door in her office complex and at the hospital to promote the Democratic plan. She took part in a Rose Garden event with Obama, was featured on PBS' "News Hour" and on MSNBC, and appeared in a video on the White House Web site.

Still, Beams said, she cringed when a close friend from college phoned and said, " 'Thank you for all your lobbying on behalf of health care reform.' And I said, 'I'm not a lobbyist!' "

A wife and mother of four children younger than 10 years old, she rises most days between 6 a.m. and 6:30 a.m. "Sometimes," the doctor said with a laugh, "I'm up at 3 in the morning."

Like Beams, whom he has never met, Gloth has been pushing his private ideas in the public arena. The goal: to influence Congress by changing public opinion.

Recent national polling has found that a plurality of Americans now oppose the plan being debated in Washington. But Gloth, who strongly opposes the legislation, takes issue with the notion that his side is winning.

"It seems like no one is happy with this," said Gloth, a faculty member at the Johns Hopkins School of Medicine and director of outpatient services for the division of geriatric medicine and gerontology at Hopkins Bayview Medical Center in Baltimore. "Over here at Hopkins, I've got very liberal folks who think that things have gotten so watered down that it'll make no difference whatsoever and conservatives who are worried that things are still moving ahead."

Gloth, 53, spends the bulk of his time in private practice, dealing with elderly patients at long-term-care facilities as medical director of a chain of Maryland nursing homes and as a Manor Care contractor. He has started an electronic medical records company and is the author, most recently, of "Fit at Fifty and Beyond."

In an effort to sway local lawmakers, he has called in to telephone town hall meetings led by members of Congress, including Democratic Rep. John Sarbanes of Baltimore, and spoken at a number of forums organized by one of the leading opposition groups in the health care fight.

Gloth said the legislation being debated in Washington would mean more bureaucracy, higher costs and greater inefficiency - and would make matters "much worse" for doctors and patients.

"You don't want to misconstrue my negativity toward this bill as saying that nothing is better than doing something," he said in an interview at a Manor Care nursing home in Catonsville. "But it can't just be change for change's sake. It has to be improvement."

Gloth has become a favorite of Americans for Prosperity, a conservative, free-market group that has stimulated popular anger with its "tea party" protests and helped organize opposition to the Democratic overhaul plan last August at lawmakers' public meetings.

"He has done everything we've asked of him," Dave Schwartz, Maryland director of Americans for Prosperity, said of Gloth, who has been a featured speaker at the group's state and national events.

The soft-spoken physician from Finksburg in Carroll County isn't a newcomer to politics. He gives what sounds like an embarrassed laugh when reminded of his unsuccessful run for U.S. Senate in 1998, when he finished third in the Maryland Republican primary.

"As a physician, this is a scary time. I've dedicated my life to taking care of the most frail and vulnerable segment of our population in what I think is a challenging environment, and I worry that it will become insurmountable," said Gloth, who begins his day at 4 a.m. to help leave time for his wife and four daughters, ages 9 to 18.

He's suspicious of cost-saving provisions to let the federal government sort out ineffective or inefficient care, and he predicts that doctors will wind up bearing an unfair burden of changes in Medicare, the federal government health insurance program for those 65 and older.

Gloth favors alternative solutions for expanding insurance coverage and reining in costs, including health savings accounts tied to a version of the Federal Employee Health Benefits Program. However, a similar idea went nowhere under President George W. Bush, who couldn't get his savings-account initiative through a Republican-controlled Congress because of Democratic opposition.

Gloth acknowledges that he's far better off financially than most geriatricians, thanks to his various ventures, but he criticizes Medicare for effectively imposing "earning caps" on doctors.

"You can be the top doc in your area and you get paid the same, sometimes less, than a physician who just finished his fellowship or his residency," said Gloth, whose father, Fred M. Gloth Jr., was a top executive of what was then known as Blue Cross and Blue Shield of Maryland.

Pediatricians also rank, along with geriatricians, internists and family practitioners, near the bottom of the physician pay scale. They would qualify for payment bonuses of 5 percent or 10 percent for some types of services under the Democratic proposals, but that would do little to close the earnings gap with highly paid specialists.

Beams, who partners with her mother, Dr. Atiya Khan, in a practice that serves 4,000 children, says she makes less money than the average Howard County elementary school teacher.

In spite of her support for the Democratic plan, she worries that provisions to speed the transition to electronic health records "theoretically would put us out of business" because of the costs, estimated at $20,000 to $60,000 for a practice like hers. (By contrast, Gloth acknowledges that if the measure became law, in spite of his efforts, it could well be a boon for his Smart E-Records venture.)

"I'm here in the trenches with these sick children and sick families every day, seeing how the system's broken," said Beams, who traces her activist streak backto her time at the Park School in Baltimore and Swarthmore College in Pennsylvania, when the causes that drew her were human rights and the environment.

She remains an active supporter of Obama's plan, even after the president effectively abandoned a provision that has been a key for her - a government-run insurance option that would compete with private insurers and make health coverage more affordable for the working-class families she treats. Beams worries that many of her patients won't be able to afford required medical insurance, even with government subsidies.

She defends the efforts of activists like herself in pressuring Congress to act, even after the compromises that have weakened the measure beyond repair in the eyes of some liberals.

It "could have died in August," she said, when opponents staged their noisy protests.

"The legislation does a lot of good things," she said, such as preventing insurers from taking away coverage or refusing to provide it in the first place because of a pre-existing medical condition, and allowing parents to retain medical coverage for their children up to age 26. "Some change is better than no change. It probably behooves us progressives to get behind the bill."

With Senate Democrats about to approve a sweeping overhaul measure in spite of unanimous opposition from Senate Republicans and widespread public doubts, Beams said she doesn't view it as a victory for her side.

"I see it as being about patients and working Americans all over the country who deserve a better health care delivery system and deserve better health security," she said. "I see it as something we need to do as a nation, for our people's well-being and the economy's stability. It's not about Democrats and Republicans or our side versus their side."


Democrats look ahead to House-Senate talks. pg 8

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