On a bright breezy morning, cheek-by-jowl with noisy Beacon Hill street traffic and busy people on the way to work, it was exhilarating to stand outside the State House interviewing advocates from around the Commonwealth who had come to lobby for health care legislation. Many older men and women animatedly milled about holding signs in favor of single payer health care.

Barbara Ackermann who reads this column in Cambridge, had urged me to come to the rally. Now age 74 and long retired from electoral office, she once served as Cambridge’s first female mayor. These days she uses her sharp political skills to lobby for fundamental change in the health care system.

Of the current situation she says, “It would cost us less to cover everybody. Half a million people in Massachusetts have no coverage at all and a lot of other people have poor coverage.”

“There’s going to be a lot of money that would be much better spent trying to fix the system,” she affirms. “The other thing that’s going wrong is that our health care providers . . . are spending a third of their time on paper work and much less of their time taking care of patients. All of these things are unacceptable.”

Gil Buckman of Brookline and his wife Rachel, both in their 80s, strongly agree:  “Trying to patch up health care is a losing proposition,”  says Gil. Rachel adds, “I wish everyone could have Medicare. We belong to an HMO but I wish younger people had that opportunity”

Though its advocates praise the single payer approach for its simplicity, nothing in American health care provision can ever be uncomplicated and straightforward. Single payer comes as close, perhaps, as possible.

The single payer for which this system is named would be a health insurance organization established by the federal government for Americans at large or, until a national plan is put into effect, by an individual state government for its residents. This scheme would thus eliminate the major role that private insurance companies currently have in health care finance.

This change of responsibility would free the overall system of many costs connected with the competition among private agencies. Expenditures for advertising, administration, overhead, and for enhancing profits would be lessened or eliminated.

Another advantage cited by advocates would be the freeing of doctors, nurses, and other health care providers from the control of insurance company administrators, a situation that currently acts as a major irritation in the working life of these health care providers.

The bill currently under consideration at the State House is called the “Massachusetts Health Care Trust.” It would make this state the first to enact the single payer system for its residents.

Two organizations, the Massachusetts Senior Action Council and the Gray Panthers of Greater Boston, have taken the lead in this rally. Both groups strongly support the Health Care Trust legislation because it would bring about reforms long championed by these two groups.

Edward Peters of Fall River is current  president of the Massachusetts Senior Action Council.  Age 73, he’s a veteran of World War II who sees the issue simply: “To me, we are the greatest industrial nation on earth but we don’t have a single system for all.” Asked if  single payer will get past the powerful forces that oppose it, he answers, “Who knows? We’re the ones who started the Revolution.”

Catherine Delorey of Boston, besides being active among the Greater Boston Gray Panthers, serves as the parent organization’s national chair. The Panthers have mounted a national campaign for the single payer system, a reform that the Panthers have been working on for almost thirty years.

To this middle-aged leader, the virtues of single payer are obvious: “It eliminates all the paperwork – –  we can then cover everyone.”  Universal coverage has special importance because the Gray Panthers has always understood itself as a coalition of old and young working for change that will benefit all Americans.

The largest elder advocacy organization in the nation, the American Association of Retired Persons, takes a different approach. Glenn Koocher, come from the Boston office to observe the demonstration, explains that AARP favors a national rather than a state-by-state approach. “We’ve always believed that the best solution lies with Congress,”  he tells me.

He summarizes a proposal first made in 1992:  “AARP has actually proposed taking Medicare, adding prescription drugs and long-term care and giving it to everybody in the United States as a single payer system – –  with the provision that large corporate entities of five thousand employees or more who could do better on their own would be allowed to opt out.”

“Basically,”  he adds, “it was a single payer scheme with comprehensive benefits and a funding mechanism which we estimated would cost a surtax of 5%.”

What are the odds that the Massachusetts Health Care Trust legislation will pass?

Richard Griffin