Your Move, Phil

In September, as Gov. Phil Bredesen was preparing to send his substantial TennCare reform proposals to Washington, D.C., for approval, he met with enrollee advocate Gordon Bonnyman, enrollee-turned-advocate Lori Smith and several others. Up until that point, the two sides—Bredesen and patient advocates—had failed to find any common ground in the effort to cut the costs of the state health insurance program for the poor and uninsurable. The writing was on the wall: Bredesen would soon threaten to gut the program entirely. The advocates, meanwhile, felt that the governor's proposed reforms would essentially castrate it anyway. So there was nothing to lose in demanding that the state do right by its most vulnerable citizens.

Smith says that when the meeting began, the governor sat down and barely made eye contact.

"I'm giving you 15 minutes of my time, and I'm talking," Smith recalls an angry Bredesen saying. "He then said, 'You've pissed me off.' He told us that this was the last chance to save TennCare, and we were getting in the way."

What happened in that brief, tense meeting typifies the negotiations between a savvy governor elected on the platform of better government management and an outmanned army of do-gooder legal hawks trying to save lives by preserving decent health insurance for hundreds of thousands of people.

To hear the governor tell it, TennCare's advocates, particularly Bonnyman, are responsible for the troubled state of the health care program. Just about every state in the country is grappling with how to keep pace with the ballooning costs of health care plans for the poor. Meanwhile, Bredesen is laying the blame for derailing the $7.8 billion program on a 57-year-old attorney who rides the bus to work. Last week, in announcing plans to remove 430,000 people from the program's rolls, Bredesen repeatedly singled out Bonnyman for crippling the program with a series of lawsuits. The governor's office also has blamed Bonnyman for obstructing the governor's budget-slashing federal waiver that aims to reform the program.

Now, having practically infuriated an entire state, Bonnyman, the founder of the nonprofit Tennessee Justice Center, has been deluged with e-mails, negative press and angry letters to the editor, all claiming that he's responsible for hundreds of thousands of Tennesseans losing their health insurance. Adding insult to considerable injury, Bonnyman claims that the governor's office even forwarded disgruntled callers to his office, though gubernatorial staffers flatly deny it.

On Monday, the plaintive lawyer announced on the Capitol steps that he would suspend the legal efforts that Bredesen has castigated for sinking the program. Speaking before a cluster of reporters and advocates, Bonnyman said that the consent decrees he's fought for have helped protect the poor and the sick and that he wasn't stepping aside lightly. But while Bonnyman was clearly conflicted about doing this, he was convinced that only by suspending the orders could he keep the state from dismantling the program. Later that afternoon, the governor extended the deadline for killing the program, although if he pulls the plug now he'll have a tougher time blaming Bonnyman.

It looked on Monday like the legal advocate wilted under pressure from the governor's bully pulpit. But what he actually did was put the onus back on Bredesen. While lawmakers from both parties say that Bonnyman's lawsuits may have helped drive up the costs of the program, there's little doubt that Bonnyman has become a convenient scapegoat for a public policy experiment that has no shortage of afflictions.

"It's been the strangest feeling to learn that myself...and a few obscure legal aid lawyers working in the basement of a public square garage somehow have more power to control the program than the governor and his staff," Bonnyman says. "That's silly."

A skilled and shrewd attorney with a track record any trial lawyer would envy, Bonnyman has spent the better part of two decades successfully suing the state for how it administers health care to its poorest and sickest residents. He has fought for enrollees to appeal the arbitrary denial of medical services and coverage and has helped the elderly receive home health care instead of living their final days in a nursing home. More than anything, Bonnyman has forced the state to follow federal law. He almost always wins.

Gov. Bredesen and lawmakers from both parties claim that Bonnyman's lawsuits have cost the state hundreds of millions and kept them from managing the program effectively. They've made Bonnyman the villain. The reality, though, is a lot more complicated. If Bonnyman had never filed a single lawsuit against TennCare, the program would still be on its deathbed and its quality of care would be considerably worse. Meanwhile, without a middle-aged lawyer to kick around, the governor would have had a tougher time explaining how a straight-talking Democrat who ran on the platform of saving TennCare had to throw hundreds of thousands of people off the program's rolls.

The governor rightly thinks that he has a mandate to reform TennCare and prevent its spiraling costs from consuming the state budget. Bonnyman, through an epic career of advocacy, sees it as his obligation to make sure that people aren't denied needed medical treatment just because they can't afford it. The two have yet to reconcile those two goals, and they may never. Monday's announcement, however, means one last chance.