Dr. Victor Kassel is an angry man.

But unlike those who nurse a silent grudge against bureaucracy, he is outspoken.Here's how he began a written report to the Utah Medical Association recently: "I accuse!

"I accuse HCFA (Health Care Financing Administration) of deliberately instituting a plan to kill off the aged sick. Active euthanasia!"

The seven-page report claims that the people who create the regulations governing Medicare are making it impossible for elderly people to get health care.

Among the complaints: Fewer doctors accept Medicare patients. Doctors who visit nursing homes are paid the same as for an office call. He adds that 97 percent of physicians refuse to go to nursing homes. Regulations penalize those who do. The volume of paperwork cuts into time a doctor can spend with patients. And more.

Kassel knows about Medicare. He's a doctor who specializes in gerontology. And whether you agree with his assessment, you have to admire the man and welcome his outrage-filled voice.

He's saying something. He's not just complaining about what he perceives as a problem. He is trying to reach the very people who can make changes. He's aiming also for those affected by the rules and regulations. I'll bet he even votes (unlike a lot of people who complain).

He's a splash of color in an-often gray world. You can't help but chuckle - and understand - when he mixes biting satire with sharp perception:

"It is my recommendation that all people must go to patients' school. I spent four years in medical school learning to be a doctor; people should spend four years in patients' school learning to be a patient. Then, one would know how to be sick according to HCFA's criteria. If a couple of my patients had known this, they would have qualified immediately for hospital care after being seen in the emergency room and not have to return later terribly ill and, shortly after admission, die."

I appreciate the anger and frustration that sparked his report. And I appreciate his willingness to share it. He's truly an advocate for the elderly.

Good advocates are hard to find. And they're not always fun to be around, especially when they've got something on their minds. They can seem obsessed (and sometimes are). They don't stop pushing if they believe in something.

They return over and over to the same theme whether they're pushing for money for programs or legislation or services to the poor, elderly, disabled and abused. They're lobbyists, but it's generally not a job so much as a passion. They believe in what they're fighting for.

Sometimes you give them what they want to shut them up. They don't mind that; what's important is that they accomplish their goals.

They serve the community. Without the advocates from the Human Services Coalition, I sincerely doubt lawmakers would have put additional funding into health and human service programs. The advocates grabbed the issue and continued to ride it, going where department heads and staff, for political reasons, couldn't go.

They are seldom thanked. Recently, the departments of Health and Human Services in Utah have scaled back their contact with some of the advocacy groups. Monthly public meetings are now bimonthly.

I think that's a shame. For one thing, the advocates are very good at bringing human needs to the attention of the public. They know who the people affected are, they know what proposed legislation means, they have a finger on the pulse of the bureaucracy. Most important, they know how the man who's not part of the bureaucracy feels. They talk to people at all levels. They go places and visit people who can't be seen from the state Capitol or heard from inside the government offices.

There've been a few times (very few, actually), when I've wanted to silence an advocate for one cause or another. I've wanted to scream, "I don't have time for this today."

Then I remember Ken Winsness, an advocate for the hungry and poor who had the capability to drive me up a wall with his very persistence. He was more tenacious than a bulldog when he was trying to break through the formality of the "system" to get something done for a client. He would badger, heckle and beg with facility. He could be kind or ascerbic. But one thing he never was: uncaring.

I sometimes wished he'd leave me alone.

He died more than a year ago. I'd give a lot if he could badger me one more time. I miss him. He spoke for people and fairness and service. He walked where bureaucrats couldn't - or wouldn't - tread.

And he believed in his causes. Like Kassel does. Like all good advocates do.