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91 7 An Impossible Dream? In the spring of 1999, in the midst of the legislative session, Vincent DeMarco had only one goal in mind: get the tobacco tax passed. So focused was he that, he confesses, he “had no idea and no plan for what to do next.” But if he was not thinking of his next campaign, that campaign was thinking of him. Not a coalition, this time, but one passionate advocate: Dr. Peter Beilenson,the health commissioner of Baltimore. At the time,Beilenson says,“I frankly could not believe that we could continue to allow ourselves to be one of three major countries left in the world— Turkey and Mexico being the others—that do not have universal health coverage . Yet we’re the wealthiest, most technologically advanced country in the world. It is simply unconscionable. There were seven hundred thousand people in Maryland then who did not have health insurance, and another seven or eight hundred thousand who had such poor health coverage that they couldn’t afford primary preventive care.” Informally, Beilenson had begun to convene other health-care advocates who had lobbied in Annapolis, year after year, for even incremental improvements in health-care coverage for Maryland’s citizens, with little success. He had also mobilized a team of ten or so public health professionals in his own department to come up with far broader reforms and a more muscular strategy. They were “good-guy granola types” with their hearts in the right place—but not strategists, he acknowledged. At one of their meetings, Carol Beck from the Abell Foundation suggested that they needed a Vinny DeMarco. Beilenson had worked in harmony with DeMarco on the gun control and tobacco tax campaigns. He also sensed that DeMarco “was about to be successful again and work himself out of a job because the tobacco tax was about to pass.” Beilenson read DeMarco as an advocate who “seemed to have a very successful template for social change through the political process” and had twice watched him successfully apply that template, though Beilenson ac- 92 The DeMarco Factor knowledged that health-care reform was a much more complex issue than either gun control or tobacco. Despite the complexity, DeMarco, who had never advocated professionally for health care, was intrigued by the prospect and agreed to explore partnering with Beilenson to lead a new campaign to achieve health care for all Marylanders. Not yet forty, Beilenson had been health commissioner for eight years under two strong-minded mayors. Like DeMarco, he is passionate about his causes, but where DeMarco is cautious and disciplined in his public statements , the Harvard-educated Beilenson is sometimes less than diplomatic, though eloquent. Thus Baltimore Sun writer Michael Ollove reported in an October 1, 2000, profile of the health commissioner: “It is his experience that only 20 percent of the population is competent in what they do. Recently he has halved that estimate.In his department,he says,bureaucratic ineptitude is as entrenched as disease in the greater community.” Ollove describes Beilenson as“tall,stringy,prematurely bald,but with the agility of a collegian.” Beilenson told about a hundred Democratic staff members at a hearing on Capitol Hill, Ollove wrote,“that he expects to do what President Clinton and Hillary Rodham Clinton could not. That he will rally a notoriously cantankerous medical profession.That he will persuade notoriously weak-willed legislators . That he will take on the formidable resources of the insurance companies ,and win.” DeMarco was no stranger to strong-minded partners, nor averse to optimism . He told Beilenson that he was ready to proceed, but cautioned that if the public will was not there for fundamental change,it would be folly to press ahead. The Challenge of Complexity Almost everyone, even most smokers, opposed smoking by kids; the only complex policy issues in the tobacco tax campaign had been, how high should we raise the tax? and who’s going to get the money? Similarly, almost every analyst who seriously looked at U.S. health care—that is, every analyst neither fettered with free-market ideological blinders nor profiting from the present system—agreed with Beilenson’s harsh assessment: the system was unconscionable. But health care was not tobacco; there was no consensus on what to do about health care,or on how to achieve health care for all. The biggest challenge for a campaign would be the deep schism among health-care advocates over the best route to health care...

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