Just a few years ago, it would have been inconceivable that the United States would adopt a health care system in which everyone could have access to medical services.  A lot of things have changed in these recent years, and universal health care doesn’t appear as outlandish as it once did. The political landscape is rapidly evolving, and ideas like universal health care are quickly gaining support among the public.

Earlier this month, former president Barack Obama appeared to endorse universal health care by mentioning it a public rally in California.  He pointed to up and coming Democratic leader who are “running on good new ideas, like Medicare for All.” Just a few years ago, a mainstream Democrat would never have publicly embraced such a divisive idea as Medicare for All, but Obama’s endorsement signals that liberals and the general public are considerably more amenable to the idea.

The Evolution of Universal Health Care in America

Universal health care in America has its origins in the late 19^th century. At about the same time, many European countries were implementing new public health programs like compulsory sickness insurance.  The U.S. government was, however, averse to using public funds to protect the public health. Instead, the federal government left this responsibility to the individual states.

In the early 20^th century, most of the initiatives to protect public health took place in the private sector rather than in government.  Major labor groups formed health insurance collectives to protect workers. However, at the same time, other major organizations like the American Federation of Labor criticized this welfare state. There was also considerable pushback from various interest groups including businesses, doctors and insurers.

Following the Great Depression of the 1930s, President Franklin D. Roosevelt tried to pass the Wagner National Health Act which would have established a national health program administered by the states.  However, FDR failed to secure enough political support for this initiative.

After World War II, many attempts to enact national health insurance failed due to a concerted effort by opposition groups.  Because the Cold War was in full swing, these attempts were often painted as socialist programs and died on the vine.

Universal Health Care in Modern Times

Since the passage of Medicare in the 1960s, there has been an ongoing debate about single-payer health insurance.  On one side is the free market which encourages consumers to purchase health insurance if and when they choose. The other side espouses mandatory coverage for all based on the best interests of public health.

In the past half century, the majority of the public has supported a free market approach, but that has started to change in these last few years. Last year, the Pew Research Center conducted a poll that found that 60 percent of the public believed the federal government should make sure all Americans have health coverage. It also found that one-third of the public now supports a single-payer health insurance system, up 12 points from 2014.

What may be more telling is the mood among young adults.  Almost 67 percent of adults younger than 30 feel that the government is responsible for making sure that all Americans are insured, and 45 percent are in favor of a single-payer system. This growing support in this key demographic suggests that a single-payer system is more likely in the near future.

Why Public Opinion is Shifting

Public sentiment is changing for many reasons, but one of the most important is the rapidly escalating cost of health care in the U.S. Between 2005 and 2015, health care inflation rose higher than the Consumer Price Index every year except 2008. This trend is also echoed in the much longer timeline from 1970 to the present.  In 1970, total national expenditure on health care was $76 billion; today it is more than $3.3 trillion.

This translates into a much heavier financial burden on households.  In 1970, the annual health care cost per American was $355. In 2016, the per capita annual burden was more than $10,000.  For a family of four, that is more than $40,000 annually, an exorbitant amount.

More Americans are also recognizing that much of this inflation is due to waste.  Almost one quarter of medical expenses goes to administrative costs. The complex and overly complicated billing system in which medical providers charge different amounts to patients, insurers or government payers is one of the key reasons for inflated costs.

Although programs like the Affordable Care Act tried to rein in costs—somewhat successfully for a short while—it also stoked the national appetite for a health care system more in line with others in other developed nations that covered all residents. Many political leaders like Senator Bernie Sanders have also voiced their support for universal health care, making it more acceptable for the public.

The Road Ahead

Although major political figures like Barack Obama and Bernie Sanders are coming out to support universal health care, it remains unlikely that a single payer system will pass through Congress any time soon. Not only is the Republican-controlled Congress firmly against such a new program, if it were to pass, President Donald Trump would almost certainly veto it.

Today, major health lobbies like insurers and pharma companies who rely on the current market would emphatically oppose universal health care.  These lobbies already invest millions of dollars to sway lawmakers and would likely shell out millions more to preserve the current system.

Finally, there is the enormous challenge of funding universal health care.  Although universal health care may cost the country much less overall, it would still cost trillions of dollars per year—an amount the federal government doesn’t possess.  In order to fund it, there would have to be a massive tax hike that the public has no desire for. This would add thousands of dollars in taxes on most households.

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