Unlike a lot of my more conservative friends, I don't think Obamacare is a "train wreck" tho I agree it has a lot of aspects that need to be fixed, but IMO the underlying U.S. health insurance system continues to be the obstacle in moving towards universal access to healthcare. The problems we are having with the health insurance and healthcare delivery system we would be having if Obamacare had not passed, just the manifestations of those underlying problems would be different.
To say it most simply, the U.S. healthcare system before Obamacare suffered from not even attempting to give everyone access to insurance that gave them access to their needed healthcare. Many people could not get insurance at all. Others thru their work, particularly working for small businesses, could only get insurance that did not cover all aspects of care, covered only a small percentage of your medical bills, or imposed other limits on how much of your needed care would be paid for. Many sick people could not get insurance at all and many healthy ones saw no reason to buy it, unless they got it through their work. Each year a smaller percentage of people in the U.S. even had health insurance.
Obamacare was an attempt to work within the mostly for profit healthcare delivery system in our country, which is a very unusual system compared to how healthcare is delivered in the rest of the world today. A deal was struck with the big powerful players in the marketplace - insurance companies, drug companies, hospitals and other providers - to offer everyone insurance with complete coverage and no limits, and not charge sick people more than healthy people for that insurance. In exchange, the government would require everyone to purchase health insurance, or pay a penalty.
But IMO the underlying problems in the U.S. healthcare system, that made the insurance regime before Obamacare so problematic, continue to make the new regime under Obamacare problematic as well. Healthcare in the U.S. costs more than anywhere else in the world. Combine that with having so many people in this country leading highly stressful lives and having very unhealthy lifestyles, you have a recipe for big problems giving everyone the access to the care they need.
The reason healthcare costs so damn much in the U.S. is from my study of history a quirk of how healthcare developed uniquely in this country. How in the early 20th century, the U.S. became enamored with big business and viewed making tons of money as the only true sign of prestige. Doctors, hospitals and the rest of the healthcare suppliers and providers got caught up in seeing themselves as a for-profit "industry" rather than as people providing a service, a ministry, to the larger community.
While most of the rest of the countries in the world were moving towards the idea of "social insurance" to pay for everyone's needed healthcare, the U.S. saw healthcare as a marketplace for making money instead. While many other countries in the world started paying to educate young people to become doctors and then ask them to spend several years providing care to underserved people, U.S. colleges charged young people large sums of money to earn their medical degrees with the promise that they could then earn lots of money plying their trade. It was all about the money, and the attached prestige that came with all that money.
So we are at a crossroads. IMO the basic question, to be provocative, is the one Bill Clinton posed some years ago. Are we all in this together or is it everyone for themselves? Are we going to have a healthcare system in this country where we all work together to keep us all healthy, or are we all better on our own, taking our chance based on what we can afford and the lifestyles we choose, paying dearly for our health "sins"?