From Otto von Bismarck to “Harry and Louise,— the idea of universal health care has fueled public debate for more than a century. Ever since major European nations adopted compulsory coverage plans, the quest for national health insurance has vexed U.S. policymakers.

Congress has tackled the issue nearly every decade, and the debate has featured a noteworthy cast of characters. Congressional leaders, Republicans, Democrats and socialists have all advocated some type of national health insurance program. But when the debate gets to Congress, attempts to enact comprehensive packages have largely failed after being hijacked by special interests. Alternative — and less comprehensive — measures carry the day.