For the first 200 years of its history, Charleston had no professional, full-time fire protection. Those with resources paid a fire insurance company, which would mount a large disk, or “plate,” on the front of their customers’ houses, with a company’s insignia.

The insurance companies hired small bands of firefighters to respond when one of their underwritten properties caught fire. If a fire company arrived at a blaze and found that it was not one of their client properties, they might stand and watch it burn to the ground. They were under no obligation to extinguish the fire.

One result of this primitive form of fire protection was that Charleston was periodically subject to devastating conflagrations which swept through the city, destroying hundreds of acres and hundreds of buildings. The last of these was the Great Fire of December 1861.

Gradually the city fathers came to understand that this piecemeal fire protection was not just bad for individual property owners, but bad for the city as a whole. To protect the individual and the community, the city needed firefighters to respond to all fires, regardless of who insured the property. Of course, it would mean levying taxes to pay for this service, and this was no doubt a tough sell in a conservative town that hated taxes and bridled at government authority. But in 1882, Charleston joined the civilized world, creating a fire department to serve the entire city. There has been no city-wide fire since that time.

Health care in this country is much like Charleston’s early fire protection. Some have insurance and some don’t. Some get the medicine and care they need and some don’t. The cost of insurance and the burden of the uninsured have become an economic threat to our economy and way of life. But where the rest of the industrialized world long ago adopted some form of comprehensive national health care, the United States continues to suffer under a 20th century health-care model in the 21st century.

Many think the solution to America’s health-care crisis will not be found until our national government does what the City of Charleston did in 1882 — ensure service for all, regardless of class, income, or need. In other words, a single-payer system with the government as the payer.

“Health-care costs are killing our economy, and that will never stop until we have a single-payer system,” David Ball told me recently at MUSC Hospital, where he is a registered nurse and clinical analyst in the Information Technology Department. He is also a member of the Charleston Healthcare Reform Committee.

To conservatives, Ball’s message is about dollars and cents. Health care is a drag on the entire economy. Health-care insurance is an added cost to manufactured products, making them non-competitive in the global market. Getting the cost of health care off the back of private companies would level the playing field for American companies.

The other industrial democracies — and some Third World countries — have adopted single-payer systems in the past 60 years; today they enjoy better and more affordable health care than we do. This should be a point of national pride, but apparently somebody in Washington is satisfied with our standing as number 37 in the quality of our health care, right behind Dominica and Costa Rica.

To liberals, Ball’s message is more human. “I think there are certain things we can expect as Americans. Having healthy citizens is a social good we need to support as a community,” Ball says. “Economically, in terms of social justice, in terms of health outcomes, this makes the most sense.”

In the debate over health-care reform, Ball knows single-payer is a long shot. It’s not even on the table for debate. To the disappointment of many Democrats, the White House plan calls for a public option in health-care insurance, but not single-payer. Ball, like millions of others, is organizing and sounding off. He will not be ignored.

In November 2006, Ball read Sen. Barack Obama’s book, The Audacity of Hope. It was a moment of startling clarity. He wrote Obama a long letter urging him to run for president and enclosed a check for a hundred dollars.

“I know about long shots,” he said. “The challenge (in the primaries) was not convincing people that Obama was the smartest guy in the room. The challenge was convincing people that he had a chance. But we proved that a guy can come out of nowhere and become president of the United States. Now we need to prove that single-payer has a chance. Once people believe that it is really possible, we can make it happen.”

David Ball and millions of other Americans are working night and day to make people believe it’s possible.

Learn more and get involved in the campaign for health-care reform. Go to