John Spritzler is a biostatistician at the Harvard School of Public Health. For decades we have been trying to get a health care system in the United States that provides good and equitable health care for all. Our efforts have been to no avail. Market-driven health care is moving in the opposite direction, making access to health care even more unequal by making it a market commodity. We have spent decades trying to persuade big business to see the obvious advantages of universal health care, even from the standpoint of their stated corporate concerns for financial and administrative efficiency. But all we have experienced is bitter failure in these efforts. Our arguments are unpersuasive to corporate leaders because many of the most powerful corporate figures view the lack of an equitable national health care system as a means of increasing the dependence of working people on their employers. Many of us have accepted the fact that we will never persuade big business to embrace universal health care. Now we're debating what to do. Some argue that, since big business will block the sweeping changes we all want, realism requires that we settle for incremental reforms of the current system acceptable to big business. Others argue that such incremental reforms do nothing to solve the fundamental problems: 1) Many people lack access to the health care they need and deserve; and 2) Health care dollars are needlessly wasted by the profit-making agendas and administrative inefficiency in our system of multiple competing health insurance companies. These people conclude that we should keep making rational arguments for the superiority of universal and equitable health care (most would agree this means a single-payer system with everybody included in one large risk pool) and hope for eventual success, despite our dismal record of failure so far. We seem trapped: What big business permits is not good enough; and what is good enough, it won't permit. To escape this trap we need a whole new approach to winning universal and equitable health care. We must stop trying to persuade big business and start organizing to defeat it. To achieve this ambitious goal, we must see ordinary Americans in a new way, and make them our allies in a fight of crucial importance to us all.   WHY HAVE WE FAILED TO RECRUIT ORDINARY AMERICANS?   We need to understand why we have failed to recruit many Americans to becoming activists for universal health care. The commonly accepted explanation�that Americans fundamentally support the status quo ("free enterprise," "capitalism," etc.)�is wrong. Americans share our goals for health care. The reason they haven't actively joined our cause is because they have very little hope that it can win. Working people have been under attack in every area of their lives for over two decades. Their jobs have been "downsized" out of existence or sped up or reduced to temp work or shipped overseas. They work increasing hours at low pay to make ends meet. Their pension plans have been decimated, their children over-tested and over-stressed at school, the social programs on which they might have relied cut back. On top of all these things, the health care available to their families is increasingly at risk. These enormous pressures on working people are not accidental. In the 1960s there was a worldwide revolutionary upsurge. People fought Soviet tanks in the streets of Prague. Over ten million French workers occupied their factories and schools and hospitals for ten days. In the U.S. militant movements for social equality and against the Vietnam War undermined elite control, while a rank-and-file labor movement challenged union officialdom and threatened corporate control of the workforce. The problems which ordinary people have experienced since the early 1970s, like the attack on health care, are part of a government and corporate strategy to strengthen elite control precisely by making people feel vulnerable and hopeless. Let us not confuse lack of hope with disagreement over goals. If most Americans truly disagreed with us over goals, then universal health care in the U.S. would indeed be an impossibility. Lack of hope, on the other hand, is something which, as I will discuss, we can turn around.   ANTI-CAPITALIST VALUES As many articles by universal health care advocates have pointed out, the public agrees with us about health care. Most Americans want good health care to be equitably available to everybody. They say this in opinion poll after opinion poll. We have a majority on our side, not just on the issue of health care but on the more fundamental question of which values should shape our society. When challenged that, in advocating removing health care from the market system, we are opposing capitalist values, universal health care advocates typically respond apologetically that, "in just this one area, health care, life should be exempt from market capitalism." The assumption behind this response is that most Americans support capitalism and that we will isolate ourselves and undermine our movement if we do not express our agreement with it. Contrary to this assumption, most Americans in fact hold values that are the opposite of the corporate values of self-interest, dog-eat-dog competition, inequality and top-down control. Despite all of the pressure from corporate power to make people compete against each other and put self-interest above commitment to each other, Americans in their everyday lives and in occasional organized efforts do the very opposite. People try, sometimes with more and sometimes with less success, to create supportive relations of trust, friendship, love, and equality with family members, neighbors and co-workers all the time without giving it a second thought. They view this as simply normal human behavior, and generally don't see the significance of these efforts as implicitly resisting capitalist values. Anti-capitalist values are the reason why people do the things they do. This is why workers stand together against company threats to lay off workers deemed "uncompetitive," why MANY students care more about friendships than about competing to prove that they are "better" than their peers, why teachers resist the standardized testing that corporate leaders are using to sort our children into winners and losers to make them fit into an increasingly unequal society, why nurses risk their jobs in strikes to prevent hospital managers from harming patients with nurse under-staffing, and why NYC firefighters sacrificed their lives in an effort to save the victims of the WTC bombing. Efforts like these, which spring from our shared humanitarian values, are the only reason why our society is not the dog-eat-dog jungle it would otherwise be. We need to grasp the full import of this fact. Ordinary Americans are an implicitly revolutionary force. Properly nurtured, this force can be made self-aware, and thereby become confident of its power, and capable of defeating even the powerful corporate minority that presently blocks all of our efforts to make health care what it should and could be. Far more than health care is at stake, because when this revolutionary force is fully mobilized, it can change the world for the better in every walk of life, from what it means to "go to work," to education, the environment and every aspect of our lives that is affected by those values that shape our human relations. THE REAL PROBLEM Working people know that the corporate and government elite are not on their side, and are not likely to provide universal health care just because people say they want it. They know that to win, it would take a mass movement powerful enough to defeat the elite. But this seems impossible because people opposed to capitalist values have been made to feel all alone: politicians, union leaders, schools and the media all insist that everybody is, and ought to be, motivated by self-interest and competition. They know that it takes large and powerful organizations controlled by working people to defeat the elite on any issue, and, given the dismal record of the labor unions, they also know that they do not possess such organizations. The problem we face is not convincing people to agree with our goals, it is giving people hope that it is possible to win. We have a majority on our side. What we don't have is a majority who are convinced that they are the majority, sure that they are right, certain that they ought to be the ones to decide what values will shape health care, and confident in their power to defeat the elite who stand in the way. These are the real obstacles that we need to overcome. Unfortunately we have been focusing all our attention elsewhere. To win universal and equitable health care we need to give Americans hope that it is possible to win a fundamental change in society that is directly opposed by the corporate and government elites who clearly hold the real power today. Explaining why universal health care is a great idea does not address this central problem.   HOW CAN WE BUILD HOPE?   To have hope, people need to see that they are not alone and they need to be confident that they are right. Our task (and the task of everybody who wants a better world) is to help people see and feel this, so that they will have the confidence it takes to build large and powerful organizations which, unlike today's unions and political parties, explicitly fight for the revolutionary values of working people and against elite power. Our most important allies resist market values like dog-eat-dog competition. They do it in their daily working lives in a Ford plant or a public school as much as in an HMO or hospital, but unfortunately many of us have been isolating ourselves from such allies by denouncing only HMO/insurance companies and by using pro-corporate arguments like, "Market values are fine in general, just not appropriate for health care." Let's go to the blue collar workers and teachers and firemen in our communities, to the professionals in non-health as well as health fields, and to working people wherever we can reach them, and say to them, "When you and we try to create positive relations with others, no matter how small the scale or personal the context, we are resisting the competitive, unequal and selfishly exploitative relations that corporate leaders try to impose. What you are already doing, without necessarily thinking of it as political, and what we are already doing in our efforts to get a health care system based on a commitment to each other instead of corporate greed, are one and the same fundamentally." Let's talk to people about their organized struggles, whether they are focused on work, education, the environment ,or any other issue, and say to them not simply, "Join our movement for universal health care," but something like this: "The values underlying your struggle for _______ and our struggle for universal health care are the same: commitment to each other, equality and democracy. The elite corporate forces we are each fighting are the same. Our struggles are pieces of the same struggle. You and we are part of a large majority. You and we are the ones who are morally right and ought to be in charge. The elite are morally wrong and have no right to the power they now wield. Neither of us is alone! Help us spread this awareness to others so that one day enough people will have so much confidence that they are not alone and that they are right that they will begin making concrete plans to actually defeat elite power in real and lasting ways." We haven't even begun to do this yet, but it is necessary to do this on a large scale to accomplish what leading activists Philip Pollner, Nancy Wooten, and Don McCanne, have called for: "reignite the spirit, reawaken hope, and foster a new campaign, permeated with trust, that will engage the cooperation and support of ordinary people and groups to commit to this cause, and no longer accept the inequities and injustice of the present health care system."   WIDER IS BETTER   We need to stop defining our goal narrowly, and take to heart an insight that economist Walton H. Hamilton expressed so well in 1932: "The organization of medicine is not a thing apart which can be subjected to study in isolation. It is an aspect of a culture whose arrangements are inseparable from the general organization of society." The general organization of our society is dominated by a corporate elite who use every institution to shape the world by their corporate values and to attack people's efforts to shape the world by anti-corporate values. The strength of our movement will come from embracing everybody who is struggling against elite values and domination, no matter in what walk of life or specific context, and appealing to their deepest feelings and motivations. If we focus narrowly�say, only on health care legislation�we will deprive ourselves of our greatest reservoir of strength. It will mean we are fighting with one hand tied behind our back. As long as the corporate elite are in power, they will undermine any narrow reform we may win. They are now turning Medicare into a servant of HMOs, and in Canada and Europe they are pushing health care in the direction of the U.S. model. A truly healthy society with a truly good health care system requires real democracy; and in a society such as ours where corporate wealth rules, real democracy is a revolutionary goal. The great majority of Americans share our implicitly revolutionary goals and can be a mighty force. It is our task to help nurture this force into a self-aware, confident movement with explicitly revolutionary goals.       John Spritzler adds an important voice to the discussion on the health care crisis in the U.S.  He is a biostatistician at the Harvard School of Public Health and an editor of New Democracy World.  Also, consider reading his related article in our Health & Medicine Section: Market-Driven Health Care and Social Control