Americans Still Favor Private Healthcare System

Americans Still Favor Private Healthcare System


  • 54% prefer private system; 42% support government-run system
  • Two-thirds of Democrats favor a government-run system
  • Majority continue to see government responsibility for ensuring coverage

Americans continue to prefer a healthcare system based on private insurance (54%) over a government-run healthcare system (42%). Support for a government-run system averaged 36% from 2010 to 2014 but has been 40% or higher each of the past five years.

Line graph. Americans prefer a healthcare system based on private insurance to a government system by 54% to 42%.

These results are based on Gallup’s annual Health and Healthcare poll, conducted Nov. 1-14. Although more Americans have warmed to the idea of a greater government role in paying for healthcare, it remains the minority view in the U.S. This could create a challenge in a general election campaign for a Democratic presidential nominee advocating a “Medicare for All” or other healthcare plan that would greatly expand the government’s role in the healthcare system.

Democratic candidates’ plans for greater government involvement in healthcare are, however, consistent with the views of their party’s base. Since 2015, after most of the Affordable Care Act’s provisions had gone into effect, an average of 65% of Democrats have favored a government-run system.

Over the same period, Republicans have been overwhelmingly opposed to a government-run system, with an average of 13% preferring that approach while 84% have wanted to retain a private system.

Independents have been closely divided in recent years, but in 2019 tilt more toward a private (50%) than a government-run (45%) system.

Compared with the five-year period spanning the ACA’s passage and implementation from 2010 to 2014, support for a government-run system has increased among all party groups, with larger increases among independents (10 percentage points) and Democrats (seven points) than among Republicans (four points).


Changes in Preferences for Private vs. Government-Run Healthcare System, by Political Party
Figures are the average percentage holding each view in the five-year period
2010-2014 2015-2019
% %
System based on private insurance 36 31
Government-run system 58 65
System based on private insurance 58 49
Government-run system 36 46
System based on private insurance 88 84
Government-run system 9 13

Majority in U.S. Say Government Has Responsibility to Ensure Healthcare

While Americans tend not to favor government-run healthcare, they do believe the federal government has a responsibility to ensure that all Americans have healthcare coverage. In the current survey, 54% hold this view, while 45% say it is not the government’s responsibility.

Recent support for the government having responsibility for ensuring healthcare coverage is not as high as it was from 2001 to 2007, when more than six in 10 Americans commonly expressed that opinion.

By contrast, from 2009 to 2014 — when the Obama administration and congressional Democrats developed, passed and implemented the Affordable Care Act — fewer Americans thought the government should ensure everyone has healthcare coverage. During that period, between 42% and 50% thought the government had that responsibility, the lowest measures in Gallup’s trend.

Line graph. Americans believe the federal government has a responsibility to ensure all in the U.S. have healthcare coverage.

Between 2009 and 2014, the percentages of Republicans and independents who thought the government should be responsible for ensuring healthcare coverage dropped at least 20 points, with a smaller eight-point drop among Democrats.

Democrats’ views are now back to where they were before 2009, while independents and especially Republicans have yet to return to prior levels, though independents are back above the majority level.

Changes in Belief That the Federal Government Has a Responsibility to Ensure All Americans Have Healthcare Coverage, by Political Party
Figures are the average percentage in each period
2001-2008 2009-2014 2015-2019
% % %
Democrats 80 72 80
Independents 64 44 56
Republicans 38 16 21
U.S. adults 62 46 54

Bottom Line

Americans have complex views on healthcare, with a majority saying the government should make sure everyone has coverage — but not necessarily pay for it through a government-run system. The Affordable Care Act was essentially an attempt to bridge these preferences by making coverage available to all through government-backed health insurance exchanges, but allowing those with insurance through an employer or other means to keep it.

Still, the law itself has been controversial, and Americans are currently as likely to disapprove of it as to approve. As such, it is fair to question to what extent Americans would embrace Democratic attempts to move to a healthcare system that goes further than the ACA does, or to support further Republican attempts to dismantle the law.

Healthcare is an issue that directly affects all Americans. Republican and Democratic political leaders have very different ideas about what healthcare policy should be. Additionally, the Democratic presidential campaign has revealed that even candidates in the same party can disagree on the best ways to address the U.S. healthcare system. With little consensus on the best way to approach healthcare policy, it promises to remain a key issue in U.S. politics and elections for the foreseeable future.




The Presidential Campaign, Policy Issues and the Public

The Presidential Campaign, Policy Issues and the Public

The U.S. presidential campaign is ultimately a connection between candidates and the people of the country, but the development of the candidates’ policies and positions is largely asymmetric. Candidates develop and announce “plans” and policy positions that reflect their (the candidates’) philosophical underpinnings and (presumably) deep thinking. The people then get to react and make their views known through polling and, ultimately, through voting.

Candidates by definition assume they have unique wisdom and are unusually qualified to determine what the government should do if they are elected (otherwise, they wouldn’t be running). That may be so, but the people of the country also have collective wisdom and on-the-ground qualifications to figure out what government should be doing. That makes it useful to focus on what the people are telling us, rather than focusing exclusively on the candidates’ pronouncements. I’m biased, because I spend most of my time studying the public’s opinions rather than what the candidates are saying. But hopefully most of us would agree that it is worthwhile to get the public’s views of what they want from their government squarely into the mix of our election-year discourse.

So here are four areas where my review of public opinion indicates the American public has clear direction for its elected officials.

1. Fixing Government Itself.

I’ve written about this more than any other topic this year. The data are clear that the American people are in general disgusted (even more than usual) with the way their government is working and perceive that government and elected leaders constitute the most important problem facing the nation today.

The people themselves may be faulted here because they are the ones who give cable news channels high ratings for hyperpartisan programming, keep ideological radio talk shows alive, click on emotionally charged partisan blogs, and vote in primaries for hyperpartisan candidates. But regardless of the people’s own complicity in the problem, there isn’t much doubt that the government’s legitimacy in the eyes of the people is now at a critically negative stage.

“Fixing government” is a big, complex proposition, of course, but we do have some direction from the people. While Americans may agree that debate and differences are part of our political system, there has historically been widespread agreement on the need for elected representatives to do more compromising. Additionally, Americans favor term limitsrestricting the amount of money candidates can spend in campaigns and shifting to a 100% federally funded campaign system. (Pew Research polling shows that most Americans say big donors have inordinate influence based on their contributions, and a January Gallup poll found that only 20% of Americans were satisfied with the nation’s campaign finance laws.) Americans say a third major party is needed to help remedy the inadequate job that the two major parties are doing of representing the people of the country. Available polling shows that Americans favor the Supreme Court’s putting limits on partisan gerrymandering.

Additionally, a majority of Americans favor abolishing the Electoral College by amending the Constitution to dictate that the candidate who gets the most popular votes be declared the winner of the presidential election (even though Americans who identify as Republicans have become less interested in this proposition in recent years because the Republican candidate has lost the popular vote but has won in the Electoral College in two of the past five elections).


2. Fix the Backbone of the Nation by Initiating a Massive Government Infrastructure Program.

I have written about this at some length. The public wants its government to initiate massive programs to fix the nation’s infrastructure. Leaders of both parties agree, but nothing gets done. The failure of the Congress and the president to agree on infrastructure legislation is a major indictment of the efficacy of our current system of representative government.


3. Pass More Legislation Relating Directly to Jobs.

Jobs are the key to economic wellbeing for most pre-retirement-age Americans. Unemployment is now at or near record lows, to be sure, but there are changes afoot. Most Americans say artificial intelligence will eliminate more jobs than it creates. The sustainability of jobs with reasonably high pay in an era when unionized jobs are declining and contract “gig” jobs are increasing is problematic. Our Gallup data over the years show clear majority approval for a number of ideas focused on jobs: providing tax incentives for companies to teach workers to acquire new skills; initiating new federal programs to increase U.S. manufacturing jobs; creating new tax incentives for small businesses and entrepreneurs who start new businesses; providing $5.5 billion in federal monies for job training programs that would create 1 million jobs for disadvantaged young Americans; and providing tax credits and incentives for companies that hire the long-term unemployed.

My read of the data is that the public generally will support almost any government effort to increase the availability of high-paying, permanent jobs.


4. Pass Legislation Dealing With All Aspects of Immigration.

Americans rate immigration as one of the top problems facing the nation today. The majority of Americans favor their elected representatives taking action that deals with all aspects of the situation — the regulation of who gets to come into the country in the first place and the issue of dealing with individuals who are already in the country illegally. As I summarized in a review of the data earlier this year: “Americans overwhelmingly favor protecting the border, although with skepticism about the need for new border walls. Americans also overwhelmingly favor approaches for allowing undocumented immigrants already living in the U.S. to stay here.”

Recent surveys by Pew Research also reinforce the view that Americans have multiple goals for their elected representatives when it comes to immigration: border security, dealing with immigrants already in the country, and taking in refugees affected by war and violence.


More Direction From the People

What else do the people want their elected representatives to do? The answer can be extremely involved (and complex), but there are several additional areas I can highlight where the data show clear majority support for government policy actions.


Americans See Healthcare and Education as Important but Don’t Have a Clear Mandate

There are two areas of life to which the public attaches high importance, but about which there is no clear agreement on what the government should be doing. One is healthcare, an issue that consistently appears near the top of the list of most important problems facing the nation, and obviously an issue of great concern to presidential candidates. But, as I recently summarized, “Healthcare is clearly a complex and often mysterious part of most Americans’ lives, and public opinion on the issue reflects this underlying messiness and complexity. Americans have mixed views about almost all aspects of the healthcare system and clearly have not yet come to a firm collective judgment on suggested reforms.”

Education is another high priority for Americans, but one where the federal government’s role in the eyes of the public isn’t totally clear. Both the American people and school superintendents agree on the critical importance of teachers, so I presume the public would welcome efforts by the federal government to make the teaching profession more attractive and more rewarding. Americans also most likely recognize that education is a key to the future of the job market in a time of growing transition from manual labor to knowledge work. But the failure of the federal government’s massive effort to get involved in education with the No Child Left Behind legislation underscores the complexities of exactly what the federal government should or should not be doing in education, historically a locally controlled part of our American society.




Fewer in U.S. See Health System as Having Major Problems

Fewer in U.S. See Health System as Having Major Problems


  • 63% say healthcare system is in state of crisis or has major problems
  • Negative ratings of system at lowest point since 2002
  • Negative views of U.S. healthcare continue to drop among Republicans

Sixty-three percent of Americans describe the U.S. healthcare system as being in a “state of crisis” (14%) or having “major problems” (49%), which is one of the least negative assessments in Gallup’s trend since 1994.

Line graph. Trend in Americans’ ratings of the U.S. healthcare system.

These data are from Gallup’s annual Health and Healthcare poll, conducted Nov. 1-14.

The 63% currently rating the system negatively is below the average of 69%, tracked by Gallup since 1994. Only once, in November 2001, did the figure stray far from the average when it dropped to 49%. That record low came just after the terrorist attacks on 9/11 when Americans’ views were temporarily more positive on a variety of measures.

Negative Views of Healthcare System Continue to Drop Among Republicans

Though Democrats’ and Democratic-leaning independents’ negative ratings of the healthcare system are lower this year than last (at 77% compared with 84% in 2018), they continue to be more negative than Republicans’ and Republican-leaning independents. Meanwhile, Republicans’ negative ratings of the system are at their lowest point since 2001, having dipped substantially each year since their peak of 80% in 2016.

Criticism of the healthcare system tends to be higher among adults who identify with the opposing party to the sitting president than among the president’s own partisans.

  • Democrats were more negative about the system during Republican George W. Bush’s presidency and each year since Republican President Donald Trump has been in office.
  • Republicans held more negative views during the latter years Democratic President Barack Obama was in office, from 2012 to 2016.
  • The pattern was different in the first few years of Obama’s presidency. During this time, Democrats’ belief healthcare had major problems or worse remained elevated, but this subsided after the Affordable Care Act (ACA) passed in 2010, and fell further once major provisions of the ACA started taking effect in 2014.
Line graph. Trend line in ratings of the U.S. healthcare system among Republicans and Democrats.

Bottom Line

Americans’ perceptions of the state of the U.S. healthcare system have been steady, with between 60% and 70% assessing it as having at least major problems. This has been consistent across four presidencies with differing approaches to healthcare policy.

The last major effort at reform — the passage of the Affordable Care Act — demonstrably lowered the uninsured rate and expanded coverage for pre-existing conditions. But the political parties’ polarized reactions to the bill’s passage suggest that a truly bipartisan effort at reform may be what’s needed to assure the majority of Americans that the system’s problems have been addressed.




43% of U.S. Households Report Preexisting Conditions

43% of U.S. Households Report Preexisting Conditions


  • 15% say they themselves have a preexisting health condition
  • 9% say they and someone else in their household have preexisting conditions
  • 19% say a family member has a preexisting condition

About one in four Americans (24%) report that they personally (15%) or they and a member of their household (9%) “have a long-term medical condition, illness or disease that would be considered a ‘preexisting’ condition by a health insurance company.” Factoring in the additional 19% who say another family member has such an illness or disease, the total percentage of U.S. households in which at least one member reports having a preexisting condition is 43%.

Americans’ Reports of Preexisting Medical Conditions in Their Household, 2018-2019
Do you, personally, or does another member of your family living with you, have a long-term medical condition, illness or disease that would be considered a “pre-existing condition” by a health insurance company?
Nov 1-11, 2018 Nov 1-14, 2019
% %
Respondent 16 15
Respondent and a family member 11 9
Family member 17 19
No one in family 54 57

These data are from Gallup’s annual Health and Healthcare survey, conducted Nov. 1-14, and are based on respondents’ self-reports. The survey does not probe about the nature of a respondent’s preexisting condition. Definitions of such conditions vary because individual insurance companies primarily determine what qualifies as a preexisting condition and what does not. They can include cancer or heart disease, but also asthma, high blood pressure or obesity.

Protecting individuals with preexisting conditions from being denied coverage by their insurers was a key tenet in Democrats’ campaign for and passage of the Affordable Care Act in 2010. It became a powerful election-year issue in the 2018 midterms for Democrats after President Donald Trump and Republicans in Congress tried to repeal the law. Gallup has found that Americans who report having a preexisting condition are somewhat more approving of the ACA than are those who do not report having such a condition.

Age Is the Biggest Differentiator in Reported Preexisting Conditions

Across key demographic groups, age stands out as the biggest factor in self-reports of preexisting conditions; the older individual Americans are, the more likely they are to report having one. About one in three adults aged 65 and older (33%) and 50 to 64 (31%) report having a preexisting condition — a rate about twice as high as what young adults aged 18 to 29 report (16%).

Aggregated data from Gallup’s 2018 and 2019 measures reveal other key differences across subgroups:

  • About a third of U.S. adults who are overweight report having a preexisting condition (32%) — much higher than the 21% among those whose self-reported weight is normal or underweight.
  • U.S. whites (29%) are more likely to report having such an illness or disease than are nonwhites (20%).
  • Women (29%) report having a preexisting condition at a higher rate than do men (21%).
  • U.S. adults living in low- (26%) and middle-income households (29%) are more likely to report having a preexisting condition than are those in upper-income households (21%).
Incidence of Preexisting Medical Conditions, Based on Self-Reported Data, by Subgroup
Do you, personally, or does another member of your family living with you, have a long-term medical condition, illness or disease that would be considered a “pre-existing condition” by a health insurance company?
Respondent personally Respondent or family member
% %
65+ years old 33 50
Overweight 32 50
50-64 years old 31 49
Democrat 31 50
Women 29 49
White 29 46
Middle household income ($40,000-$99,999/year) 29 45
Lower household income (less than $40,000/year) 26 43
Independent 24 42
30-49 years old 23 40
Republican 22 40
Men 21 38
Upper household income ($100,000 or more/year) 21 45
Normal weight/Underweight 21 39
Nonwhite 20 38
18-29 years old 16 38
Data aggregated from 2018 and 2019 polls

Across political party groups, Democrats (31%) are more likely to report having a preexisting condition than are independents (24%) and Republicans (22%). A Gallup analysis finds that across age and weight groups, Democrats are more likely than Republicans to report having a preexisting condition. This might suggest that some respondents are answering the question through a political lens — with Democrats more sensitive to the issue of preexisting conditions and therefore more likely to report having one, and Republicans more inclined to downplay the issue and less likely to report having such a condition themselves.

Bottom Line

As many Americans shop for healthcare plans in the current ACA open enrollment period, a sizable percentage of them will need to navigate a market that includes plans that may not provide them with coverage for preexisting conditions. The Trump administration is encouraging consumers currently on the ACA individual market to seek out short-term private plans that in many cases do not protect those with preexisting conditions. These new, non-ACA plans are now available during the ACA’s seventh annual open enrollment period after the administration loosened restrictions on them last year in an effort to offer more affordable alternatives to ACA plans.

The ACA’s provision on preexisting conditions has survived many challenges. Public officials of both major political parties have expressed commitment to the issue and have offered various plans to protect Americans with preexisting conditions from being denied coverage. But Americans have been lukewarm about the law that made the largest breakthrough on the issue — though it is a bit more popular among those who report having a preexisting condition themselves.




More Americans Delaying Medical Treatment Due to Cost

Image result for More Americans Delaying Medical Treatment Due to Cost


  • A third of U.S. adults say their family couldn’t afford care in past year
  • One in four say care was deferred for a serious medical condition
  • Lower-income adults and Democrats most likely to report delayed care

A record 25% of Americans say they or a family member put off treatment for a serious medical condition in the past year because of the cost, up from 19% a year ago and the highest in Gallup’s trend. Another 8% said they or a family member put off treatment for a less serious condition, bringing the total percentage of households delaying care due to costs to 33%, tying the high from 2014.

Gallup first asked this question in 1991, at which time 22% reported that they or a family member delayed care for any kind of condition, including 11% for a serious condition. The figures were similar in the next update in 2001, and Gallup has since asked this question annually as part of its Health and Healthcare poll. This year’s survey was conducted Nov. 1-14.

Americans’ reports of family members delaying any sort of medical treatment for cost reasons were lower in the early to mid-2000s when closer to a quarter reported the problem. Since 2006, the rate has averaged 30%.

The pattern is similar for the subset of Americans postponing medical treatment for a serious condition. The rate rose from 12% in 2001 to an average of 19% since 2006. However, the current 25% is the highest yet, exceeding the prior high-point of 22% recorded in 2014.

Income Gap Widens for Cost-Related Delays for Serious Conditions

Reports of delaying treatment for a serious condition jumped 13 percentage points in the past year to 36% among adults in households earning less than $40,000 per year while it was essentially flat (up a non statistically significant three points) among those in middle-income and higher-income households.

As a result of the spike in lower-income households this year, the gap between the top and bottom income groups for failure to seek treatment for a serious medical condition widened to 23 percentage points in 2019. The income gap had averaged 17 points in the early years of Barack Obama’s presidency, but narrowed to an average 11 points in the first few years after implementation of the ACA, from 2015 to 2018.

Line graph, 2003-2019. U.S. adults saying family put off medical care for serious condition due to costs, by household income.

Delayed Care Up Most Among Those With Pre-Existing Conditions

Reports of delaying care for a serious condition due to costs are also up 13 points compared with last year among Americans who report they or another household member has a “pre-existing condition.”

At the same time, there has been virtually no change in the percentage of adults without pre-existing conditions in the household who delayed care for a serious health issue in the past year, currently 12% versus 11% in 2018.

Changes in health insurance coverage don’t appear to be the cause of the increase in delayed care as the percentage uninsured is 11% in the poll, within the 9% to 11% range seen each year since 2015. Also, the percentage delaying care has increased a similar proportion among those covered by private health insurance or Medicare/Medicaid as well as among the uninsured.

Recent Reports of Delayed Care May Have a Partisan Component

A cautionary note in the new findings is that most of the recent increase in reports that family members are delaying treatment for serious conditions has occurred among self-identified Democrats. This is up 12 points since 2018 among Democrats, compared with three- and five-point increases among Republicans and independents, respectively.

This ties in with Democrats’ higher likelihood than Republicans of reporting that they or a household family member has a pre-existing medical condition.

Whether these gaps are indicative of real differences in the severity of medical and financial problems faced by Democrats compared with Republicans or Democrats’ greater propensity to perceive problems in these areas isn’t entirely clear. But it’s notable that the partisan gap on putting off care for serious medical treatment is currently the widest it’s been in two decades.

Line graph, 2003-2019. U.S. adults saying family put off medical care for serious condition due to costs, by party ID.


Since 2001, Gallup has tracked a near 50% increase in the percentage of Americans saying that they or a family member chose not to get medical care because of the costs they would have to pay. Such delays in medical treatment, whether for injuries, illnesses or chronic conditions, can have significant implications for the economy and healthcare system, but also the political climate.

One indicator of the stress that delayed care can put on the healthcare system is the use of emergency departments. According to the American Hospital Association, patient visits to emergency departments in community hospitals increased 19% between 2001 and 2016 and has likely climbed to over 20% by today. While that may reflect many factors, including the aging of the population and the number of Americans living in close proximity to hospitals, it may also be indicative of a greater need for emergency care due to lack of routine care.

While most of the increase Gallup sees in delayed treatment occurred over a decade ago, the sharp increase in the past year, particularly among Democrats, suggests that healthcare costs could be a more potent political issue than previously seen. Presidential candidates who acknowledge the problem and propose solutions to address it may find a receptive ear among voters.

From an economic perspective, delayed care can have a range of negative effects, including reduced workplace productivity in the short-term, and increased healthcare costs and in the long-term — costs that ultimately burden the federal budget which has ripple effects on the economy.