Seeking to tap into widespread discontent with inaction by Congress and the Statehouse, the referendum would require the Legislature to find a way to provide health insurance coverage for all by mid-2002 in a state where more than 600,000 people lack it. It would also introduce a patients' bill of rights that would guarantee patients the freedom to choose their doctors and guarantee doctors the freedom to choose the right treatment for their patients. And it would put a temporary ban on the conversion of nonprofit hospitals to for-profit.

Similar white-coat rebellions are in the works elsewherecampaigners in Washington State, too, are close to getting a measure calling for universal health care onto the state ballot for this fall, which would make this the first campaign season in which more than one state had a universal care
initiative on the ballot, experts say. In a handful of other states -- Arizona, Arkansas, Oklahoma and Montana -- campaigns backing narrower health care proposals, like requiring tobacco
settlement money to go toward health, are using ballot initiatives as well. "What is happening is an enormous backlash by the public," said Dr. Bernard Lown, a Nobel prize laureate and a leader of the Massachusetts initiative drive.

A push to overhaul the health care system, he said, "has to come from below, from the state level; you're closer to the people, you're closer to their pain, and they're more readily mobilized." He and other campaigners say they believe a convergence of several factors is at work in their favor. They point to the swelling numbers of uninsured people, the trouble that many patients have paying for their prescription drugs, the spiraling costs of medical care and the widespread complaints from
doctors and nurses that new constraints are keeping them from offering the best care to their patients.

The opposition appears readily mobilized as well. Here in Massachusetts, the Coalition for Health Care, which is running the ballot campaign, is already opposed by the Committee for Affordable Health Care Choices, which unites business associations, managed care organizations
and other insurers. "We're just getting into campaign readiness," said Richard C. Lord, its
spokesman and president of the state's biggest business association. "But it's probably going to take millions of dollars, because if you want to get your message across to the voters, you need to advertise and that's very expensive." His group's message, he said, will include the points that the initiative could destroy the networks that are the very basis of managed care, and could throw the health care system into chaos by the beginning of next year. The committee also argues that the initiative is overly vague in that it calls for universal health care but does not specify how it is to be paid for. Several commissions in recent years have been stymied by the question of who would pay that bill, Mr. Lord noted.

The initiative's backers counter that the vagueness was intentional, because it allowed the formation of a coalition that included those who favor a Canadian-style single-payer system, those who favor a Hawaii-style requirement that employers provide health insurance, and others. "People have been specifying the funding mechanisms forever, and they've been losing," said John O'Connor, the campaign's co-chairman and a veteran campaigner for environmental causes. "We want to keep the majority of voters together on the concept that everybody has to be covered by a date certain,"
July 1, 2002. Judging by polls and the signature-gathering outside the Statehouse on Friday, support is indeed broad for the general idea of universal coverage. A few passers-by withheld judgment, but several signed with alacrity. "I'm definitely for universal health care," said Shuang Wang, a 21-year-old intern at the Statehouse, "though I don't know where the money is going to come
from." Another signer, Tom McCarron, a lobbyist on transportation issues, said, "I just think it's vitally important that people be covered for health care. The cost of it is just out of control."

Proposals for universal coverage have been made repeatedly in recent years around the country, since well before the Clinton administration tried to overhaul the country's health care system in the early 1990's. In liberal Massachusetts, a universal health care proposal was even enacted into law in the late 1980's, though the Statehouse went from Democrat to Republican and the economy from flush to hard up, and the measure was repealed before it took effect. Usually, measures calling for universal health care and other sweeping changes have tended to go down to defeat, said Diane Lardie, national coordinator of Uhcan, the Universal Health Care Action Network, a national
group based in Cleveland. They have come up in more than 20 states beginning in Ohio in 1989, Ms. Lardie said, but usually either failed to make it onto the ballot or died in a legislative committee or on the floor of one house or another. "One of the difficulties with something like a health care issue is that health care is so complex that people are scared," she said, "and they're willing to say, 'Don't do anything,' as opposed to 'Change it for the better' because they're afraid it won't be for the better."

The Massachusetts and Washington State initiatives are important bellwethers to gauge whether public opinion has indeed shifted, Ms. Lardie said. Maryland, too, is "ahead of the pack," she said. There, a political push for universal health care is under way, though it involves no referendum this
year. Oregon, as well, is a spot to watch. Campaigners there had planned a referendum on a health care overhaul this season, they said, but postponed it, in part because action is under way on the legislative front. Also, Gov. John Kitzhaber of Oregon, a doctor, called for universal health care
insurance for all Oregonians earlier this year, saying he hoped to work out a proposal for the 2001 Legislature.

In Massachusetts, other political avenues are being pursued. State Senator Richard T. Moore, the Senate chairman of the Legislature's joint committee on health care, said he was confident that legislators would pass their own patients' bill of rights within the next month or so, one that would include the possibility of external review for patients denied care by their managed care providers. In addition, he said, a commission appointed by the governor to examine health care financing, quality and safety is to begin meeting next week. He is concerned, Senator Moore said, that the ballot initiative "really goes too far."

Dr. Harris A. Berman, the chief executive of Tufts Health Plan here, also opposes the initiative, arguing that it can be expected to raise the price of health care significantly by taking away H.M.O.s' ability to control costs. To him, the very existence of the initiative, which tries to "use oversimplification to solve a very complex problem," is counterproductive. "In a health care system hurting as badly as Massachusetts'," Dr. Berman said, "with every hospital and just about every health plan losing money and home health care operations going out of business, to spend millions of
dollars that should be used on health care on this fight is just a travesty." But campaigners say they will soldier on, regardless of criticism and possible legislative action, convinced that universal health care would save money by improving access to preventive care and thus avoiding expensive
emergency room visits. And, they said, it is also the morally correct path.

John Kenneth Galbraith, the economist, has lent his name to the campaign and said he was supporting the initiative because he joined "with all sensible people in not wanting to see anyone die because they can't afford the requisite medical treatment." He said he had grave doubts about whether health care "can be a business enterprise, where one saves money by cutting back care."