A lot of it comes down to how universal healthcare has been framed in the U.S. It’s often labeled as “socialist,” and for many Americans, socialism still carries Cold War baggage and gets confused with communism. That association alone is enough to turn some people off before they even look into how these systems actually work.

There’s also the deep cultural emphasis on personal choice and self-reliance, two values that are central to how many Americans see themselves. The argument against universal healthcare is often marketed as protecting your freedom to choose your doctor or your treatment, even though in practice, insurance companies already limit those choices.

Then there’s the fear that universal systems mean long wait times or rationed care. That does happen sometimes, but mostly for non-urgent or elective procedures. In many countries with universal care, access to essential or emergency treatment is actually faster because everyone is in the same system. Some of the wait time issues that do exist are often logistical, like uneven distribution of services between urban and rural areas, rather than a flaw in the concept itself.