> But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations.

The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...)

That's not meaningful access to healthcare for someone making $30k a year.

My uncle-in-law just signed up for health insurance under ACA in Colorado. He pays a $22/mo premium and has a $700 max out of pocket. Yes, 2 zeros. I was totally shocked but I reviewed all his paperwork and it’s true. Meanwhile I’m paying $1,200/mo for a young and healthy family of 3 with a $7,000 max out of pocket.

Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe.

http://www.healthreformbeyondthebasics.org/cost-sharing-char...

Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.

And people wonder why the us has such poor health outcomes

The worst tactical move the "left" has ever done in the US is allow itself to be tied ideologically to the ACA. To my outsider's view this is nothing but an entrenchment of the 'feudal' nature of the US health care system, and a direct subsidy to private insurance companies (even if obligations were forced on them). From a pragmatic POV I see why it was put in place, but frankly it's just awful.

If the Health Care system HAS to be a feudal system I would much rather be tied to the government than a job that can fire me at any time for any reason or one I have to stick to if anything serious happens.