**1. Introduction**

This is the U.S. story—from the birth of health insurance responding to genuine human need in the depths of the Great Depression in the 1930s—to the opulence of a massive corporatized industry today exploiting that need all the way to the bank. How do we explain that turn-around? This chapter has four goals: (1) to bring some historical perspective to that question; (2) to briefly summarize how health care services are bought and paid for in the U.S.; (3) to describe how private health insurance and multi-payer financing have failed the public interest; and (4) to compare four reform alternatives currently under consideration, only one of which will bring lasting reform through universal coverage.
