I don't run with other people in my group much, but I do have a mechanism that works pretty well
I use something like:
/cast [target=focustarget,help] [target=focus] lesser healing wave
for my main healing macro. Focus is my tank. If my tank is targetting a friendly unit, it will heal them. If not, it will heal the tank. The only problem with this macro is lag. When you change targets (as you will when somebody needs a heal), there is a small period of time until the server updates the other client(s) about that change. If you hit the button before that update (around 1/3-1/2 second in my experience), you will heal the tank instead. Unfortunately, I only tend to use this when somebody's in trouble, so time is a factor, but I've adapted to the lag and just have learned to wait a little bit after switches.
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