“THE REPUBLICAN PARTY will soon be known as the party of health care—you watch,” President Donald Trump declared in March. “We’re coming up with plans.” Alas, like many of Mr Trump’s claims, this one proved untrue. Days later, following conversations with Mitch McConnell, the Republican Senate majority leader, Mr Trump admitted via tweet that his much-touted health-care proposal would in fact be delayed until at least 2021 after “Republicans hold the Senate & win back the House”.

Republican reluctance to embrace health care, despite the president’s best efforts, is understandable. On the one hand, America’s health-care system is woefully dysfunctional: the country spends about twice as much on health care as other rich countries but has the highest infant-mortality rate and the lowest life expectancy (see chart). Some 30m people, including 6m non-citizens, remain uninsured. And yet, though costs remain a major concern—out-of-pocket spending on insurance continues to rise—Americans say they are generally satisfied with their own health care. Eight in ten rate the quality of their care as “good” or “excellent”. Few are in favour of dramatic reform.

So far the Trump administration has struggled to make headway. Mr Trump tried and ultimately failed to replace Obamacare, his predecessor’s signature health-care law. Since then, he has focused on proposals to rein in the cost of prescription drugs, including tying the prices of some medicines to those in other rich countries and requiring drug companies to disclose their list prices in television advertisements. This month, the president called on Congress to end “surprise” medical bills, the unexpected charges that patients often face after receiving treatment. Such measures, though welcome, are unlikely to make a dent in a system that gobbles up $3.5trn a year.

Today Democrats in Congress will have their say when the House Budget Committee holds a hearing on single-payer health care. Such a system would expand access to medical care and bring down costs by allowing the federal government to negotiate directly with providers. Polls show that Americans like the idea in theory. In practice, however, many are unwilling to accept the necessary trade-offs, including longer waiting times, less access to pricey medical treatments and higher taxes. For proof consider the experiences of Colorado, California and Vermont, left-leaning states that have all tried to implement their own single-payer systems in recent years. All of them have failed.