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George Romney’s private-sector experience typified the business world of his time. His executive career took place within a single company, American Motors Corporation, where his success rested on the dogged (and prescient) pursuit of more fuel-efficient cars.41 Rooted in a particular locale, the industrial Midwest, AMC was built on a philosophy of civic engagement. Romney dismissed the “rugged individualism” touted by conservatives as “nothing but a political banner to cover up greed.”42 Nor was this dismissal just cheap talk: He once returned a substantial bonus that he regarded as excessive.43 Prosperity was not an individual product, in Romney’s view; it was generated through bargaining and compromises among stakeholders (managers, workers, public officials, and the local community) as well as through individual initiative. When George Romney turned to politics, he carried this understanding with him. Romney exemplified the moderate perspective characteristic of many high-profile Republicans of his day. He stressed the importance of private initiative and decentralized governance, and worried about the power of unions. Yet he also believed that government had a vital role to play in securing prosperity for all. He once famously called UAW head Walter Reuther “the most dangerous man in Detroit,” but then, characteristically, developed a good working relationship with him.44 Elected governor in 1962 after working to update Michigan’s constitution, he broke with conservatives in his own party and worked across party lines to raise the minimum wage, enact an income tax, double state education expenditures during his first five years in office, and introduce more generous programs for the poor and unemployed.45 He signed into law a bill giving teachers collective bargaining rights.46 At a time when conservatives were turning to the antigovernment individualism of Barry Goldwater, Romney called on the GOP to make the insurance of equal opportunity a top priority. As

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What American Healthcare Can Learn from Italy: Three Lessons It’s easy. First, learn to live like Italians. Eat their famous Mediterranean diet, drink alcohol regularly but in moderation, use feet instead of cars, stop packing pistols and dropping drugs. Second, flatten out the class structure. Shrink the gap between high and low incomes, raise pensions and minimum wages to subsistence level, fix the tax structure to favor the ninety-nine percent. And why not redistribute lifestyle too? Give working stiffs the same freedom to have kids (maternity leave), convalesce (sick leave), and relax (proper vacations) as the rich. Finally, give everybody access to health care. Not just insurance, but actual doctors, medications, and hospitals. As I write, the future of the Affordable Care Act is uncertain, but surely the country will not fall into the abyss that came before. Once they’ve had a taste of what it’s like not to be one heart attack away from bankruptcy, Americans won’t turn back the clock. Even what is lately being called Medicare for All, considered to be on the fringe left a decade ago and slammed as “socialized medicine,” is now supported by a majority of Americans, according to some polls. In practice, there’s little hope for Italian lessons one and two—the United States is making only baby steps toward improving its lifestyle, and its income inequality is worse every year. But the third lesson is more feasible. Like Italy, we can provide universal access to treatment and medications with minimal point-of-service payments and with prices kept down by government negotiation. Financial arrangements could be single-payer like Medicare or use private insurance companies as intermediaries like Switzerland, without copying the full Italian model of doctors on government salaries. Despite the death by a thousand cuts currently being inflicted on the Affordable Care Act, I am convinced that Americans will no longer stand for leaving vast numbers of the population uninsured, or denying medical coverage to people whose only sin is to be sick. The health care genie can’t be put back in the bottle.