Background Memo on Universal Health Care Coverage

Written by Adam Knopsnyder

Since the start of the 20th Century, there have been multiple attempts of public policy initiatives to ensure access to health care for all in the United States of America. Throughout this time, the federal government has enacted a variety of policies that have created and expanded programs that try to offer health insurance to those who are unable to find private medical insurance. One policy option that has been considered for over 75 years is a single payer form of health care. This policy option eliminates the need for multiple private insurance companies by creating a single public agency that is responsible for financing the health care costs of all citizens (Christopher, 2016). Even though the United States federal government has never instituted a complete form of single payer healthcare, there have been not only attempts at getting such a policy passed, but elements of a single payer system, such as the idea of a public option, have been put into place and are a part of the current US healthcare system. This post aims to outline the history of the single payer healthcare policy in the United States.

The first American president to consider single payer healthcare as a policy initiative was Franklin D. Roosevelt, who originally wanted to incorporate the policy into the New Deal, but decided not to include it because of the American Medical Association’s strong objection at the time (Oberlander, 2019). After World War II, President Harry Truman became the first US president to formally endorse the idea of nationalized healthcare, but was unable to successfully pass legislation in Congress in order to enact such a policy (Oberlander, 2019). Then, in 1965, under the Lyndon B. Johnson administration, Medicare and Medicaid was passed into law, which offered government-ran health insurance to senior citizens and low-income families, respectively (Oberlander, 2019). Medicare and Medicaid were the first public policies to allow the federal government to act as a health insurance provider, which gave senior citizens and low-income individuals who could not get covered by private insurance companies or afford them the chance to get coverage.

From the initial passing of Medicare and Medicaid in 1965 to the 1990s, there were a number of amendments and policy initiatives which expanded eligibility to allow more Americans access to the government health care option, including those with permanent disabilities, children, and pregnant women (Oberlander, 2019). Since the 1990s, there has been only one other attempt at increasing access to government-ran healthcare, which came with the passing of the Affordable Care Act by President Barack Obama in 2010. The ACA greatly expanded the Medicaid program to allow even more individuals with lower incomes to gain access to the public option, however the ACA did not do anything to expand health insurance coverage via Medicare to older citizens (Oberlander, 2019). Throughout the last century, the basic concept of a single payer healthcare system has been seriously considered and even used as a basis for public policy initiatives in the United States. However, a true single payer system has yet to be enacted at the federal level of government, always leaving some Americans reliant on private insurance companies or going uninsured.


Christopher, A. S. (2016, June 27). Single payer healthcare: Pluses, minuses, and what it means for you. Harvard Health Blog.

Oberlander, J. (2019). Lessons From the Long and Winding Road to Medicare for All. American Journal of Public Health, 109(11), 1497–1500.

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