I have been involved in social programs relating to public health for my entire adult career of over 30 years.  Although I think the programs I was involved with were badly needed, they never got the social-political support they needed to be significant and effective.  Everytime a politician or lay person would try to make such a social program more comprehensive, there would always be that conservative politician out there crying socialism and this is not the American way.  

The idea of rugged individualism, and you have to do it for yourself, must be deeply ingrained in the American psyche, and overcoming that ingrained sentiment, IMO, is the largest obstacle in the way of progressive ideals.  To put it another way, it is sort of like an institutional bias that has evolved with the country, and will be/is an enormous challenge to overcome!