Since the dawn of the 20th century, a debate over health care has raged in America.

The debate centers around the argument over whether the federal government is obligated to ensure that its citizens have health care, thus preventing them from economic headaches associated with rising costs of basic medical care. 

Historian and sociologist Paul Starr wrote in his book, Remedy and Reaction: The Peculiar American Struggle over Health Care Reform, that efforts to “provide all Americans access to medical care and protect them from economic ruin” have long been a “liberal inspiration.” 

Beginning in the early decades of the 20th century, reform from the Progressive Era gave Americans antitrust laws, labor legislation, the Federal Reserve and workers’ compensation, but reforming health care proved to be more challenging. 

Reform has come slowly. After the New Deal, social security was passed to give seniors a fiscal safety net in their later years. Along with social security came the GI Bill and the minimum wage. 

For decades liberals sought a system of universal health care that would protect all Americans from the pain of illness and burdensome medical bills. 

With the establishment of Medicare and Medicaid, progressives hoped they had broken through — not so.

Starr wrote that “if Americans came to know one thing about the history of battles over health insurance, it was that a government program to make health care a right of citizenship had always been defeated.”

Early ideas for government-led health insurance programs came from Europe. 

British national health care and German sickness funds were unpopular and never gained traction in America. Workers compensation shows similarities to German sickness funds, but the idea of national health care similar to Britain was, to the chagrin of progressives, politely frowned upon in the States. 

In 1912, progressives within the Republican Party established the Progressive Party that included in its platform support for social health insurance. 

Canada boasts a single payer system with striking similarities to the United States' Medicare system. Progressives had hoped that the Medicare system would serve as a precursor to a more wide-reaching program to establish a system for all Americans, offering insurance akin to the coverage offered to seniors by Medicare. 

President Bill Clinton spent a good chunk of political capital on an attempt at health insurance reform in 1994, but progressives split over whether an employer mandate should be used to force universal coverage. 

Instead, progressives began to adopt an idea known as the individual mandate, an idea identified with moderate Republicans in the 1990s (Starr). 

A century of trying to produce health care reform produced mixed results, but progressives saw a ray of hope when Massachusetts crafted a health care system that would become the reference for health care proposals drafted by candidates during the 2008 election. 

When President Barack Obama took up the issue of health insurance reform, progressives sought to avoid the problems that plagued the reform efforts in the 1994 debate.

A small window for progressives opened in 2008 after Democrats gained control of both houses of Congress as well as the White House. 

Unlike Clinton, Obama left the writing of the bill to Congress, including the following specifics: What services to cover, whom to cover, how much to subsidize coverage, and how to play for the expansion of coverage and control cost.  

Much like Clinton, Obama spent a lot of political capital on crafting a bill to curve rising health insurance premiums. 

In 2010, progressives would take a centrist approach in hopes of coupling insurance reform with long-term deficit reduction. 

Persons opposed to health care reform and assumed government intervention in one of America’s largest industries have called the Patient Protection and Affordable Care Act “socialized medicine” or “government health care.”

In reality, none of the proposals in the United States even closely resemble true government health care like Britain’s universal health care system.

Reality shows that Democrats largely played on Republican turf. 

Coupling reform with deficit reduction, championing the originally Republican idea of the individual mandate and dropping advocacy for a government-run “public option” meant that Democrats sought compromise on the bill.

They sought agreement on one of the most divisive issues in America's history. Agreement may have been sought, but discord was found. 

Perhaps the fact that the debate requires Americans to draw upon deep-seated ethical principles precludes agreement. 

Or perhaps the problem is deeper. 

Perhaps Americans are truly divided over the role government should play in people’s lives. 

Americans fought for independence from a “tyrannical” king in England. Now, Americans are fighting for a government that maximizes the freedom so desperately craved by our founding fathers.