How much public insurance do Americans want?

Lane Kenworthy, The Good Society
November 2021

What kind of public safety net do Americans want?

Our main source of information is several long-running public opinion surveys: Gallup surveys, the American National Election Study (NES), the General Social Survey (GSS), and surveys by the Pew Research Center. Americans tend to have very limited understanding of socioeconomic issues, and few devote much effort to getting better informed. As a result, many have shallow, weak views and preferences about most issues.1 Even so, the survey data suggest discernible patterns to public opinion in the aggregate: it doesn’t tend to fluctuate randomly, on many issues it is remarkably consistent over time, and when it shifts, it tends to do so in explicable ways.2 We can therefore treat these survey data as a useful, if imperfect, indicator of what Americans think and want.

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MOST AMERICANS DISLIKE THE IDEA OF BIG GOVERNMENT

As figures 1-3 suggest, Americans tend to believe that individual effort, rather than luck, determines success in life. They also tend to feel they are able to get ahead economically, as figure 4 indicates. These considerations might lead to a conclusion that extensive government assistance is unnecessary.

Figure 1. People get ahead by hard work more than by lucky breaks or help from others
Share of US adults. Response options: hard work, lucky break or help from others, both equally. The line shows the share choosing hard work. Data source: General Social Survey, sda.berkeley.edu, series getahead.

Figure 2. Disagree hard work offers little guarantee of success
Share of US adults. Response options: disagree completely, disagree mostly, agree mostly, agree completely, don’t know. The line shows the share choosing disagree completely or disagree mostly, with don’t know responses excluded. Data source: Pew Research Center, Trends in American Values: 1987-2012, p. 136.

Figure 3. Disagree success in life is pretty much determined by forces outside our control
Share of US adults. Response options: disagree completely, disagree mostly, agree mostly, agree completely, don’t know. The line shows the share choosing disagree completely or disagree mostly, with don’t know responses excluded. Data source: Pew Research Center, Trends in American Values: 1987-2012, pp. 135-36.

Figure 4. Agree people like me and my family have a good chance of improving our standard of living
Share of US adults. Response options: agree strongly, agree, neither, disagree, disagree strongly. The line shows the share choosing agree strongly or agree. Data source: General Social Survey, sda.berkeley.edu, series goodlife.

In addition, many Americans don’t trust that government will act effectively. As figures 5-10 show, most have only some or hardly any confidence in the president and Congress, a majority only sometimes or never trust the government to “do what is right,” half don’t believe government is run for the benefit of all the people, and many think government waste is commonplace.

Figure 5. Only some or hardly any confidence in the executive branch of the federal government
Share of US adults. Response options: a great deal, only some, hardly any. The line shows the share choosing only some or hardly any. Data source: General Social Survey, sda.berkeley.edu, series confed.

Figure 6. Only some or hardly any confidence in Congress
Share of US adults. Response options: a great deal, only some, hardly any. The line shows the share choosing only some or hardly any. Data source: General Social Survey, sda.berkeley.edu, series conlegis.

Figure 7. Only some of the time or almost never trust the government in Washington to do what is right
Share of US adults. Question: “People have different ideas about the government in Washington. These ideas don’t refer to Democrats or Republicans in particular, but just to government in general. We want to see how you feel about these ideas. How much of the time do you think you can trust the government in Washington to do what is right?” Response options: just about always, most of the time, only some of the time, almost never, don’t know/depends. The line shows the share choosing only some of the time or almost never, with don’t know/depends responses excluded. Data sources: American National Election Study, sda.berkeley.edu; Pew Research Center, “Beyond Red vs. Blue: The Political Typology,” 2014, p. 149.

Figure 8. Disagree the government is really run for the benefit of all the people
Share of US adults. Response options: disagree completely, disagree mostly, agree mostly, agree completely, don’t know. The line shows the share choosing disagree completely or disagree mostly, with don’t know responses excluded. Data source: Pew Research Center, Trends in American Values: 1987-2012, p. 138.

Figure 9. People in government waste a lot of the money we pay in taxes
Share of US adults. Response options: waste a lot, waste some, don’t waste very much, don’t know. The line shows the share choosing waste a lot, with don’t know responses excluded. Data source: American National Election Study, sda.berkeley.edu, series trustgov_waste.

Figure 10. Government is almost always wasteful and inefficient
Share of US adults. Question: “Next are some pairs of statements that will help us understand how you feel about a number of things. Please choose the statement that comes closer to your own views — even if neither is exactly right. Government is almost always wasteful and inefficient; government often does a better job than people give it credit for.” The line shows the share choosing almost always wasteful and inefficient, with both, neither, don’t know, and refused responses (usually less than 5%) excluded. Data source: Pew Research Center, 2019 American Trends Panel.

For these reasons and perhaps others, many Americans favor limited government.3 For instance, when asked whether they would “rather have a smaller government providing fewer services or a bigger government providing more services,” usually more than half say they prefer a smaller government providing fewer services, as figure 11 indicates. And as figure 12 shows, nearly half say “the less government the better” as opposed to “there are more things that government should be doing.”

Figure 11. Prefer smaller government providing fewer services rather than bigger government providing more services
Share of US adults. Question: “If you had to choose, would you rather have smaller government providing fewer services or bigger government providing more services?” The line shows the share choosing smaller government with fewer services, with it depends and don’t know responses excluded. Data source: Pew Research Center, 2020 American Trends Panel.

Figure 12. The less government, the better
Share of US adults. Question: “Which one is closer to your views: the less government the better or there are more things that government should be doing?” Data source: American National Election Studies, electionstudies.org.

MOST AMERICANS LIKE PUBLIC INSURANCE PROGRAMS

The public opinion data above buttress the impression that Americans are averse to activist government. Yet they hide a deeper truth: while Americans are ideologically conservative when it comes to the size and scope of government, they are programmatically progressive. They dislike big government in the abstract, but they like a lot of the things government actually does, including most public insurance programs.4

This isn’t too surprising. The more income or assets people have, the more insurance they tend to be willing to buy. Affluence also allows and encourages people to care more about fairness for others. Public insurance programs mitigate risk and enhance fairness. Consequently, as countries get richer, they tend to allocate a larger portion of their income — their gross domestic product (GDP) — to insurance.5

This doesn’t mean the American public is constantly clamoring for new or bigger public insurance programs. Indeed, in examining public opinion on the major social policy innovations of the 1930s and the 1960s, Katherine Newman and Elisabeth Jacobs find considerable ambivalence and/or opposition among ordinary Americans to the proposed programs. The public, according to Newman and Jacobs, had “mixed and contentious attitudes about activist government.” Policy advances owed mainly to the efforts of political leaders, particularly Franklin Roosevelt and Lyndon Johnson, who “moved boldly into a policy vacuum or forged on against growing antagonism. They pushed and pulled legislators into creating and then sustaining the progressive history of the 1930s and 1960s.”6

Once public insurance programs are in place, however, people are better able to form an opinion about them. If a program works well, and there don’t appear to be any major adverse side effects, Americans tend to like it.7

Social Security expenditures are approximately 3.5% of GDP in the United States.8 Most Americans like the program and if anything want it expanded. The General Social Survey regularly asks a set of questions prefaced by the following statement: “We are faced with many problems in this country, none of which can be solved easily or inexpensively. I’m going to name some of these problems, and for each one I’d like you to tell me whether you think we’re spending too much money on it, too little money, or about the right amount.” Figure 13 shows that more than half say current Social Security spending is too little. And if we add those who think current spending is about right, the share is greater than 90%.

Figure 13. Spending is too little or about right on Social Security
Share of US adults. Response options: too little, about right, too much. Data source: General Social Survey, sda.berkeley.edu, series natsoc.

Government expenditures on education and health care amount to 7.5% and 9% of GDP, respectively.9 This spending also is quite popular. Figure 14 shows that a large majority thinks we spend too little on “improving the nation’s education system,” and nearly all Americans feel either that we spend too little or that currently spending is about right. In 2007, Benjamin Page and Lawrence Jacobs asked a representative sample of Americans “Would you be willing to pay more taxes in order to provide early childhood education in kindergarten and nursery school.” Two-thirds were willing, versus just one-third unwilling.10

Figure 14. Spending is too little or about right on improving the nation’s education system
Share of US adults. Response options: too little, about right, too much. Data source: General Social Survey, sda.berkeley.edu, series nateduc.

Figures 15, 16, and 17 show similarly strong support for spending on health in general and on Medicare and Medicaid specifically.11 Figure 18 shows that about 90% of Americans think it should be government’s responsibility to provide health care for the sick. Figure 19 shows half of Americans believe it should be the federal government’s responsibility to help people in paying for medical care. Figure 20 shows that half or more of Americans agree it is the federal government’s responsibility to make sure all Americans have health care coverage. A 2007 survey asking “Would you be willing to pay more taxes in order to provide health coverage for everyone?” found nearly 60% support.12 As figure 21 indicates, a sizable majority of Americans say they support taxpayer-funded national health insurance, though if the question asks specifically about a “government” health insurance plan, the level of support isn’t quite as high.

Figure 15. Spending is too little or about right on improving and protecting the nation’s health
Share of US adults. Response options: too little, about right, too much. Data source: General Social Survey, sda.berkeley.edu, series natheal.

Figure 16. Spending is too little or about right on Medicare
Share of US adults. Question: “As you know, there are many competing spending priorities facing the President and Congress. Thinking about the federal budget, do you want to see the President and Congress increase spending on Medicare, decrease spending, or keep it about the same?” Data source: Kaiser Family Foundation, kff.org.

Figure 17. Spending is too little or about right on Medicaid
Share of US adults. Question: “As you know, there are many competing spending priorities facing the President and Congress. Thinking about the federal budget, do you want to see the President and Congress increase spending on Medicaid, decrease spending, or keep it about the same?” Data source: Kaiser Family Foundation, kff.org.

Figure 18. It should be government’s responsibility to provide health care for the sick
Share of US adults. Question: “On the whole, do you think it should or should not be the government’s responsibility to provide health care for the sick.” Response options: definitely should be, probably should be, probably should not be, definitely should not be. Data source: General Social Survey, sda.berkeley.edu, series hlthcare.

Figure 19. It is the responsibility of the federal government to help people in paying for medical care
Share of US adults. Question: “In general, some people think that it is the responsibility of the government in Washington to see to it that people have help in paying for doctors and hospital bills; they are at point 1. Others think that these matters are not the responsibility of the federal government and that people should take care of these things themselves; they are at point 5. Where would you place yourself on this scale?” The line shows the share choosing point 1 or point 2. Data source: General Social Survey, sda.berkeley.edu, series helpsick.

Figure 20. Agree it is the responsibility of the federal government to make sure all Americans have health care coverage
Share of US adults. Question: “Do you think it is the responsibility of the federal government to make sure all Americans have health care coverage, or is that not the responsibility of the federal government?” Response options: yes government responsibility, no not government responsibility, no opinion. Data source: Gallup, “Health Care System,” gallup.com.

Figure 21. Favor national health insurance
Share of US adults. National health insurance: Question: “Do you favor or oppose national health insurance, financed by tax money, and paying for most forms of health care?” Response options: favor, oppose, don’t know. The line shows the share responding favor, with don’t know responses excluded. Data source: CBS-NYT. Reported in the data set for Benjamin Page and Lawrence Jacobs, Class War? What Americans Really Think about Economic Inequality, University of Chicago Press, 2009, variable qhc2. Single-payer plan: “Do you support or oppose having a national health plan — or a single-payer plan — in which all Americans would get their insurance from a single government plan?” Response options: support, oppose, don’t know, did not answer. The line shows the share responding support, with don’t know and did not answer responses excluded. Data source: “A Slim Majority of Americans Support a National Government-Run Health Care Program,” Washington Post, 2018. Government health insurance plan: “Some people feel there should be a government insurance plan which would cover all medical and hospital expenses for everyone. Others feel that medical expenses should be paid by individuals, and through private insurance plans like Blue Cross. Where would you place yourself on this [7-point] scale?” The line shows the share choosing responses 1-3, with don’t know responses excluded. Data source: American National Election Studies, electionstudies.org, table 4A.3.

There also is considerable support for government action to help the poor. Expenditures on Social Security, disability insurance, the EITC, unemployment insurance, workers compensation, housing assistance, food assistance (SNAP, WIC, and school lunches), and TANF amount to 6% of GDP.13 Pew polls find 60-75% of Americans believe “it is the responsibility of the government to take care of people who can’t take care of themselves,” as shown in figure 22. Figure 23 indicates that a majority of Americans think we are spending too little on assistance to the poor. Figure 24 shows that about half of American adults feel the government should help more needy people even if it means going deeper into debt. And figure 25 shows that a third think the federal government should do “everything possible to improve the standard of living of all poor Americans.” The EITC is America’s largest antipoverty program apart from Social Security. In 2007 Page and Jacobs asked whether the EITC should be increased, decreased, or kept about the same. More than 90% wanted it increased or kept the same.14 Finally, when Gallup and Pew have asked Americans whether the statutory minimum wage should be increased, they have consistently found 70% or more in favor, as figure 26 indicates.

Figure 22. Agree it is the responsibility of the government to take care of people who cannot take care of themselves
Share of US adults. Response options: disagree completely, disagree mostly, agree mostly, agree completely, don’t know. The chart shows the share choosing agree completely or agree mostly, with don’t know responses excluded. Data source: Pew Research Center, Trends in American Values: 1987-2012, p. 148.

Figure 23. Spending is too little on assistance to the poor
Share of US adults. Response options: too little, about right, too much. The line shows the share choosing too little. Data source: General Social Survey, sda.berkeley.edu, series natfarey.

Figure 24. Agree the government should help more needy people even if it means going deeper into debt
Share of US adults. Response options: disagree completely, disagree mostly, agree mostly, agree completely, don’t know. The line shows the share choosing agree completely or agree mostly, with don’t know responses excluded. Data source: Pew Research Center, Trends in American Values: 1987-2012, p. 148.

Figure 25. The federal government should do everything possible to improve the living standards of all poor Americans
Share of US adults. Question: “Some people think that the government in Washington should do everything possible to improve the standard of living of all poor Americans; they are at point 1. Other people think it is not the government’s responsibility, and that each person should take care of himself; they are at point 5. Where would you place yourself on this scale?” The line shows the share choosing point 1 or point 2. Data source: General Social Survey, sda.berkeley.edu, helppoor.

Figure 26. Favor raising the minimum wage
Share of US adults. Response options: favor, oppose, don’t know. The line shows the share choosing favor, with don’t know responses excluded. Data sources: Gallup, gallup.com; Pew Research Center; pollingreport.com.

There is only one noteworthy exception to the popularity of existing public social programs in the US: “welfare.” In the GSS surveys, relatively few say we currently spend too little on welfare, as figure 27 indicates. Though the question doesn’t specify the particular program, it’s likely that most respondents have in mind Aid to Families with Dependent Children (AFDC), which was replaced in the mid-1990s by Temporary Assistance for Needy Families (TANF). As Martin Gilens has documented, AFDC was a uniquely unpopular program with the American public.15 This owes to a variety of factors, according to Gilens, prominent among them race and media portrayals. This perception is deeply ingrained. Despite the pronounced changes introduced by the 1996 welfare reform — strict time limits on benefit receipt, reduced benefit levels, stronger employment requirements — the General Social Survey responses suggest little, if any, shift in public opinion about “welfare” since then.

Then again, it’s worth emphasizing that in spite of the widespread dislike and stigmatization of “welfare,” around half of Americans typically say our spending on it is either about right or too little.

Figure 27. Spending is too little or about right on welfare
Share of US adults. Response options: too little, about right, too much. Data source: General Social Survey, sda.berkeley.edu, series natfare.

HAVE AMERICANS’ VIEWS SHIFTED IN RECENT DECADES?

Have Americans’ opinions about government’s role or about specific social programs changed over time? According to the public opinion data, there has been little change. As the trend lines in virtually all of the charts shown here suggest, Americans’ views about government effectiveness and how much we should be spending on particular policies have remained fairly constant.16

SUMMARY

Many Americans dislike the idea of big government. But when it comes to public insurance, they’re not at all averse to a government that is medium-sized or even large.

  1. Angus Campbell, Philip E. Converse, Warren E. Miller, and Donald E. Stokes, The American Voter, University of Chicago Press, 1960. ↩︎
  2. Benjamin I. Page and Robert Y. Shapiro, The Rational Public, University of Chicago Press, 1992; Robert S. Erikson, Michael B. MacKuen, and James A. Stimson, The Macro Polity, Cambridge University Press, 2002. ↩︎
  3. Seymour Martin Lipset, American Exceptionalism, W.W. Norton, 1996; John Micklethwait and Adrian Woolridge, The Right Nation, Penguin, 2004; Alberto Alesina and Edward L. Glaeser, Fighting Poverty in the US and Europe, Oxford University Press, 2004. ↩︎
  4. Christopher Ellis and James A. Stimson, Ideology in America, Cambridge University Press, 2012. ↩︎
  5. Most of what we call social policy is actually public insurance. See Lane Kenworthy, “Public Insurance and the Least Well-Off,” The Good Society. ↩︎
  6. Katherine S. Newman and Elisabeth S. Jacobs, Who Cares? Public Ambivalence and Government Activism from the New Deal to the Second Gilded Age, Princeton University Press, 2010, pp. 5, 7. ↩︎
  7. Paul Pierson, Dismantling the Welfare State? Reagan, Thatcher, and the Politics of Retrenchment Cambridge University Press, 1994. ↩︎
  8. Yonatan Ben-Shalom, Robert Moffit, and John Karl Scholz, “An Assessment of the Effectiveness of Anti-Poverty Programs in the United States,” 2010, table 1. This number includes only cash payments for retirees; it excludes disability payments. ↩︎
  9. OECD, Education at a Glance; OECD, Health at a Glance. ↩︎
  10. Data set for Page and Jacobs, Class War?, variable qtaxm. ↩︎
  11. In 2011 the Pew Research Center found 61% of Americans saying “people on Medicare already pay enough of the cost of their health care” versus just 31% saying “people on Medicare need to be more responsible for the cost of their health care in order to keep the program financially secure.” Pew Research Center, “Public Wants Changes in Entitlements, Not Changes in Benefits,” 2011, p. 24. ↩︎
  12. Data set for Page and Jacobs, Class War?, variable qtaxl. ↩︎
  13. Ben-Shalom, Moffit, and Scholz, “An Assessment of the Effectiveness of Anti-Poverty Programs in the United States,” table 1. This number is for 2007. ↩︎
  14. Data set for Page and Jacobs, Class War?, variable qjob4. ↩︎
  15. Martin Gilens, Why Americans Hate Welfare, University of Chicago Press, 1999. ↩︎
  16. See also Jeff Manza, Jennifer A. Heerwig, and Brian J. McCabe, “Public Opinion in the ‘Age of Reagan’,” in Social Trends in American Life, edited by Peter V. Marsden, Princeton University Press, 2012. ↩︎