For advocates of true healthcare reform, spring is in full bloom. April brought two important surveys and a high-profile investigative television report, all of which were supportive of national health insurance such as a "single-payer" system. California health professional students continue to add even more voices to the chorus. Will the California Medical Association join in?

In a study printed in the April Annals of Internal Medicine, Indiana University School of Medicine researcher Aaron Carroll found that 59 percent of physicians--and a majority across almost every specialty--favor "government legislation to establish national health insurance."

Two weeks later, the PBS Frontline special "Sick Around the World" focused on lessons that the United States can learn from the national healthcare systems of five other democracies. And a late-April Field Institute poll reported that the proportion of Californians preferring to receive healthcare coverage "through the government" rose by nine percentage points since 2006, while preference for "individual responsibility" dropped six points.

These "April showers" of information are a clarion call for true healthcare reform that fulfills the five guiding principles defined in the Institute of Medicine's 2004 report, Insuring America's Health: Principles and Recommendations. The five principles are:

Universality--Everyone in, nobody out, where "everyone" means everybody, as compared to recent state initiatives, where universal healthcare will never be achieved by design.
Continuity--Care that is life-long, automatic and guaranteed.
Affordability--Care that is accessible to families and individuals.
Sustainability--A system of care to which everyone contributes, and that simplifies billing, regulations and underwriting requirements.
High quality--Care that is patient-centered and evidence-based, with the goal of improving the population's health.

California medical students get it. In January 2006, more than 125 of us gathered in Sacramento for the first-ever Lobby Day created entirely by medical students in support of state Sen. Sheila Kuehl's SB 840, the state's only reform effort that upholds the IOM's criteria. In 2007, we brought more than 200 students. This January, we grew even larger and broader. A coalition of more than 350 health professional students left our classrooms and clinical responsibilities to amass in Sacramento, holding more than 100 legislative visits that secured four co-authorships.

And not just health professional students, but specifically CMA Medical Student Section members get it. Many of the students involved in planning and attending Lobby Day have held CMA-MSS leadership roles both on their campuses and in the statewide organization. In 2006, the CMA-MSS Congress endorsed a single-payer approach to health insurance reform. And this month in Chicago, CMA-MSS leaders introduced legislation calling upon the American Medical Association to endorse the IOM guiding principles.

Will CMA redefine its value system to unambiguously embrace what physicians want, what its students have been advocating for more than two years, and what patients are literally dying for? Such a redefinition would value healthcare as a social good, rather than as another widget produced in response to the market.

What is most puzzling is the CMA's lack of a clear endorsement of national health insurance, even while it expends a major part of its advocacy contesting violations by companies thriving under the current system. Not a CMA Alert arrives without the next twisted and horrid tale of such follies, along with CMA's save-the-day efforts to protect physicians. For example, the April 28 Alert's lead article, "United Healthcare Cutting Physician Fees Without Notice," is followed by an update on the latest racketeering lawsuit against Blue Cross/Blue Shield.

Ultimately, the imperative of true, universal healthcare transcends our 59-percent physician support, and even public support. Huge social and environmental issues loom on the horizon, and creating a universal healthcare system is the minimum preparation we can make for the potential impact on health that will result from such environmental eventualities as polar ice-cap melting.

Healthcare reform consistent with the IOM is inevitable and it is near at hand. My optimism springs from the belief that we have almost fulfilled Winston Churchill's quip that "Americans will always do the right thing--after they've tried everything else." Along with hundreds of other medical students and other CMA-MSS members, I invite the CMA for a stroll through the resplendent fields of change.