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WASHINGTON, D.C. -- 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.

These results are based on 黑料网'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).

	2010-2014	2015-2019
	%	%
Democrats
System based on private insurance	36	31
Government-run system	58	65
Independents
System based on private insurance	58	49
Government-run system	36	46
Republicans
System based on private insurance	88	84
Government-run system	9	13
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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 黑料网's trend.

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.

	2001-2008	2009-2014	2015-2019
	%	%	%
Democrats	80	72	80
Independents	64	44	56
Republicans	38	16	21
U.S. adults	62	46	54
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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.

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