In the United States, there are two major camps when it comes to healthcare.

There are those who believe healthcare is a commodity – on the same playing field as cars and jewelry.

Or as one surgeon wrote in the New England Journal of Medicine in 1971 – “Medical care is neither a right nor a privilege – it is a service that is provided by doctors and others to people who wish to purchase it.”

And there are those, like intensive care doctor and single payer advocate Adam Gaffney, who see it as a human right.

Gaffney has a new book out – To Heal Humankind: The Right to Health in History (Routledge, 2018).

Gaffney traces the debate throughout history. And in reading the book, you realize – the push for single payer in the United States is just part of the ongoing historic battle between the two camps.

One star of Gaffney’s book is Aneurin Bevan, a politician from Wales who helped push through the National Health Service Act of 1946 in the UK.

During the debate over the bill, there was a question as to whether the wealthy should be included in the service.

“Society becomes more wholesome, more serene and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide,” Bevan said.

And the National Health Service was put in place by 1948. Everyone was included.

“Shortly before its onset, a four-page leaflet was mailed to every house and apartment to announce the new system, and the text of this document speaks to its comprehensiveness and universality,” Gaffney writes.

“‘The NHS,’ its first page reads, ‘will provide you with all medical, dental, and nursing care.  Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except for a few special items.”

“‘There are no insurance qualifications.’ The document proceeds to describe how, from age 16 and up, everyone can select the doctor of her choice, and how the NHS would cover maternity services, ‘all forms of treatment in general or special hospitals,’ mental healthcare, surgical care, prescription drugs, dental care, eye care, and ‘home health services’—all without charge. ‘From then on,’ as historian Rudolf Klein puts it in his history of the service, ‘everyone was entitled, as of right, to free care—whether provided by a general practitioner or by a hospital doctor—financed by the state.’”

Bevan was eventually appointed Minister of Labor, but resigned in 1951 when the government opened the door to co-pays for prescription drugs and glasses.

Fast forward to today.

Gaffney is a single payer advocate with Physicians for a National Health Program.

And last week PNHP said it could not support a single payer bill to be introduced by Senator Bernie Sanders if the bill included co-pays or deductibles – mirroring Bevan’s complaint in his resignation speech.

Where would Gaffney draw the line?

Gaffney too would not support a bill that has co-pays and deductibles.

The Sanders’ bill reportedly would only cover U.S. citizens – not everybody residing in the country.

Where would Gaffney come down on that contentious issue?

“As a caveat to what I’m about to say, let me say this – I very well may welcome a single payer bill, even though I don’t agree with every element in it,” Gaffney told Single Payer Action podcast host Russell Mokhiber. “I am in favor of covering everybody in the country, not just citizens. We can afford it. It’s the right thing to do. And I’m very much in favor of covering everybody, regardless of citizen status.”

“In terms of deal breakers – it does have to be a real single payer system. And I understand that the Sanders’ bill is going to be a real single payer system. A prolonged transition period, I’m not in favor of. But that’s also more of a mechanics issue, a practical issue that we might disagree with. It’s not so much an issue of deep principle.”

“Co-payments I feel much more strongly about. I feel very strongly that co-payments not play a major role and I would prefer zero role. I’ll have to read the bill in its entirety and see what it does. I’m not hearing there’s going to be an opt-out. I’m hearing it’s going to be real single payer. And I have heard that the role for co-pays may be small. But I haven’t read the bill. We’ll have to see. We’ll know soon enough. And we’ll be able to make an informed judgement.”

The weakness of many single payer proposals is sketchiness on the finances. What plan do you favor?

“HR 676 includes payroll taxes, a tax on the top five percent of income earners and a couple of other taxes,” Gaffney said. “But it’s not delineated in incredible depth. In theory, my approach is progressive taxation. That helps address the issue of income inequality, while simultaneously creating a single payer system. I would prefer some combination of progressive taxes on income and wealth.”