AbstractThe analytical methods of John R. Commons, including his emphasis on security of expectations, transactions and the importance of public sovereignty, are applied to the issues of health care reform. Historically the development of the third-party payment system has improved security of expectations, reduced the economic power of the health care provider, and created a rationing transaction for health care. This analysis and Commons’ advocacy for compulsory health insurance to be provided through mutual insurance companies under control of employers, government, and workers supports a single-payer system of universal health care coverage under public governance today.