According to the New York Times today, Americans show surprising clarity about financing health care: “Half of those questioned said they thought government would be better at providing medical coverage than private insurers, up from 30 percent in polls conducted in 2007. Nearly 60 percent said Washington would have more success in holding down costs, up from 47 percent.” (See In Poll, Wide Support for Government-Run Health)

Despite the scare tactics of the insurance companies, hospitals, and professional associations and the intense lobbying that the health care industry is engaged in, there is an underlying fact that the public seems to have grasped: in a society where health care has become a business, the best way to hold down costs is to remove the profit motive. Businesses have to make money: hospitals have to turn a profit, insurance companies and manufacturers of drugs and medical equipment must earn a return for their investors, providers are encouraged to become entrepreneurial. It adds up, of course.

In a review of a new book by Ezekiel J. Emanuel on reforming health care, Dr Arnold Relman, Professor at the Harvard Medical School and former editor of The New England Journal of Medicine, makes the essential point: “No other health care system is as focused on generating income as ours, and in no other country is medical care marketed and advertised so aggressively, as if it were just another commodity in trade.” (See The Health Reform We Need & Are Not Getting) Our enthusiasm for free markets, for privatizing essential services, our horror at “socialized medicine,” at government control, have pushed us down this path – and too many interests are at stake to make any significant change seem possible.

So this underlying fact has disappeared from our debates on the subject, our conversations, and from our conscious minds. Even the book that Dr. Relman reviews, written by the brother of Obama’s Chief of Staff, Rahm Emanuel – a good book with lots of useful ideas, according to Relman – fails to make that point.

But, in its way, the public knows it. They are not preoccupied with the political problem of what is possible to get through Congress, or how to contend with special interests and their powerful lobbies, or how to get re-elected. But they have their day-by-day encounters with buying drugs, paying bills, filling out insurance forms, sitting in emergency rooms, losing jobs and losing coverage. They may not be able to think it or speak it clearly, but they know the underlying truth of the situation. Only government is not out to make a profit.