One major impediment to passing a universal health care bill is that such a large proportion of voters already have health insurance. And one major reason so many voters have health insurance is that senior citizens, who are disproportionately likely to vote, are all covered by a pre-existing government program. But if there were no Medicare, then seniors would be a major constituency in favor of reform, rather than a bloc that is, at best, indifferent. Tyler Cowen speculated the other day that “If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?”
Catherine Rampbell at The New York Times has some data to back this up, noting that seniors—who are already beneficiaries of a government guarantee of health care—are disproportionately likely to oppose a government guarantee of health care:
I assume that were seniors not in a position to benefit from a special, wildly popular “universal health care for old people only” program that they would look more kindly on creating a universal health care program.
That said, in terms of 1970s health care counterfactuals you don’t even need to reach that far. Back when Richard Nixon was president there was substantial support from Nixon and congressional moderates for creating the sort of hybrid health care system that congress is currently contemplating. Nowadays, liberals, though not necessarily in love with this idea, are perfectly willing to support it as an act of political pragmatism. In the early 1970s, however, they were holding out for something more so the idea didn’t really go anywhere. I assume that had liberal members of congress been able to peer 30 years into the future they would have chosen to strike a deal with Nixon back in the day.