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Ask Americans about the U.S. health care system and you’ll find a lot of agreement, as 70% say it has “major problems” or is “in a state of crisis,” according to a new Gallup poll.

In fact, since at least 1994, that amount of concern has been fairly constant. The one exception was immediately after the September 11 attacks in 2001 when only 49% thought there were major problems or a crisis. By the next year, attitudes returned to normal.

Part of this is due to expense. Rising insurance premiums are a concern for 61% of Americans, and 46% are worried they won’t be able to afford their care.

Another issue is care delivery. Both Republicans and Democrats are concerned about getting coverage for pre-existing conditions. U.S. health care outcomes also trail far behind other industrial countries, even though the per capita cost here is in the top three globally.

While average concerns over health care are historically steady, the mix of who feels most negative varies with shifts of political power. Over time, partisans have taken turns blaming one another for the mess, as Axios notes. During the George W. Bush administration, Democrats were more likely to say the system was in a crisis. Under Barack Obama, it was Republicans. And with Trump, again Democrats find more fault.

Given that the system doesn’t change that radically time and time again, there’s the question of whether people really find health care a problem or use it as an unconscious proxy for dissatisfaction with leadership.

[“source=fortune”]