Paul Ellwood is angry. Fortunately, he has the guts to say why.

At a Harvard University conference May 1, Dr. Ellwood reportedly startled listeners with a forceful indictment of America's health- care system. Quality is eroding, he said, and nobody's doing anything about it.

The pediatric neurologist also may be feeling some guilt. He led the influential Jackson Hole group that played a huge role in health care's tumultuous reorganization. He coined the term "health maintenance organization" and is called the "father of HMOs." The "managed competition" concept President Clinton chose for his failed national plan of 1994? Paul Ellwood's.

I met Dr. Ellwood at a 1993 meeting, where he explained to members of Florida's new Community Health Purchasing Alliances, known as CHPAs, how market forces would increase health-care quality while lowering costs. Admittedly, he said, it was a complex experiment, "a little like a moon shot, where all the pieces eventually come together, only this time the pieces are millions of
Floridians."

Today, Dr. Ellwood, 72, is still considered a premier health- policy leader. So when he calls health-care quality "unacceptable" and urges government regulation, people listen.

Competition has succeeded in bringing down costs, he says, but it also has brought down quality. As for the savings, health-care inflation, he predicts, will soon return "with a vengeance." Ironically, his denunciation springs in part from a personal run-in with the health-care system, one of those
"anecdotes"  managed-care companies like to dismiss as isolated. And his experience didn't involve an HMO.

A year ago, Dr. Ellwood fell from his horse and crushed a vertebrae in his neck. If his spinal cord had been severed - which could have resulted from a sudden move afterward - he would have been in the same condition as Christopher Reeve. That he's not is no thanks to the care he received. In the hospital, a protective collar to immobilize his head came off, and a nurse didn't know how to put it back on. The next day, a surgeon refused his request for a surgically
installed brace. A second surgeon also refused because he wasn't referred by the first physician. And other horribles.

"It doesn't make any difference how powerful you are or how much you know," Dr. Ellwood said. Later, when members of his family also received poor care, his frustration grew.

Now, the man who convinced the country that market forces would solve the nation's health-care problems has changed his mind. Money, he now realizes, does more than talk. It shouts, drowning out discussion of anything else.

Still, financial problems remain. Last year, 21 of Florida's 35 HMOs reported fourth-quarter losses, the Florida Hospital Association said last week.

Perhaps the most intriguing question, however, is why Dr. Ellwood ever thought that turning health care over to for-profit companies would improve quality. Now, he suggests creating a government agency, perhaps patterned on the Federal Aviation Administration, to ensure quality. He urges others to speak out. Quality will become a priority, he told The Boston Globe, only when
political pressure demands it, "which is why I say these things."

Who will join him? Last Sunday, Elizabeth Dole was booed at a Republican gathering for endorsing some sensible gun-control measures. Her comments may be courageous or canny politics or both. But she's saying what most of Americans think.

Which presidential hopeful will endorse Dr. Ellwood's call to improve health-care quality? Or do we have to wait for Al, Bill or George W. to fall off a horse?

Fran Hathaway is an editorial writer for The Palm Beach Post. Her e-mail address is fran-hathaway@pbpost.com