Reacting to rising expenditures on insurance, corporate managements cut back on employee health benefits, triggering worker unrest. Consider the five-month strike against supermarket chains in Southern California--the longest in the industry's history. It left about 60,000 union workers jobless, and it seriously hurt the owners as well. The central issue--in a state where half of all personal bankruptcies are related to medical bills--was the demand by Safeway, Kroger and Albertsons that members of the United Food and Commercial Workers (UFCW) union pay much more for health benefits. The settlement, reached last February, sent a grim message to grocery workers everywhere.

The strike "would not have occurred if we had a system of universal healthcare coverage," Greg Denier, assistant to the international president of the UFCW, told me. "All of our strikes in the past decade have occurred because of the absence of universal healthcare." Moreover, universal health coverage would have narrowed the wide gap in operating costs between the unionized chains and nonunion competitors, particularly 800-pound gorilla Wal-Mart. Unlike the chains, the world's biggest retailer charges so much for miserly health insurance that more than 60 percent of its poorly paid employees (averaging $8 an hour) don't buy it. Denier saw the strike as a symptom of "the slow-motion collapse of the employment-based healthcare system."

Lawyer Harry Burton represented Safeway and Giant Food in subsequent negotiations with the UFCW in the Washington, DC, region. Speaking "as an individual," he essentially agreed with Denier. Universal health insurance would have "a profound effect" not just on the supermarket industry but "on nearly all collective bargaining," he told me. Nonunion companies "virtually never" provide healthcare of the same quality as that provided by unionized competitors, thus creating "a vast disparity in costs." That's why a tax-supported national system would result in "a leveling of the playing field." I asked Burton what explains the resistance or indifference of employers to universal health insurance. "Very frequently it's ideology," he replied.

Business leaders worship marketplace ideology "almost like religion," says Raymond Werntz, who for nearly thirty years ran healthcare programs for Whitman Corporation, a Chicago-based multinational holding company. "It's emotional." In 1999 Werntz became the first president of the Consumer Health Education Council in Washington, a program of the Employee Benefit Research Institute, a nonprofit, nonpartisan group. He saw it as his mission to try to persuade employers to face the "huge, huge" issue of the uninsured because, he told me, "business has to be involved with the solution." The problem that emerged was its "unwillingness to even think about a solution." Last year, after funding ran out, a disappointed Werntz became the council's last and only president.

Publicly financed universal health insurance comes in different forms. For Americans, however, none should hold more interest than single-payer. It's "one and the same thing" as Medicare for everybody, Werntz told me. Does the Corporate America that's happy with Medicare understand this? I asked. "It's a dialogue that hasn't happened yet," he replied. "My life for four years was trying to get business people in a room with single-payer people. I couldn't do it." CEOs of large corporations see it as something "that smacks of socialism," Werntz said, and therefore as "heresy."

Somehow, they don't see Medicare as heresy. Yet it's largely why the tax-financed share of US health spending is "the highest in the world," according to Drs. Steffie Woolhandler and David Himmelstein, associate professors at Harvard Medical School and founders of Physicians for a National Health Program. Writing in the July/August 2002 issue of Health Affairs, they put the share at 59.8 percent. No wonder: Federal tax revenues pay for Medicare, Medicaid and the medical-care systems for the military, the Veterans Administration, federal employees and Congress; income-, sales- and property-tax revenues buy coverage for state and local public employees. Taxation also hugely subsidizes health insurance while benefiting mostly "the affluent," the authors noted.

In 1991 the GAO made a stark finding regarding single-payer's benefits: "If the universal coverage and single-payer features of the Canadian system [had been] applied in the United States" in that year, "the savings in administrative costs"--$66.9 billion--"would have been more than enough to finance insurance coverage for the millions of Americans who are currently uninsured," the GAO said in a report. The $3 billion left over "would be enough...to permit a reduction, or possibly even the elimination, of copayments and deductibles."

Early this year, a comprehensive study published in the International Journal of Health Services reached this stunning conclusion: "The United States wastes more on health-care bureaucracy than it would cost to provide health care to all its uninsured." The authors, Woolhandler, Himmelstein and Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, went on to write: "Administrative expenses will consume at least $399.4 billion of a total health expenditure of $1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately $286 billion in 2002, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage."

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