It took superhuman effort, a once-in-a-lifetime political opportunity, and some outright shenanigans even to get the Affordable Care Act passed. It was a very minor tweak to the existing system, and half the country viewed it as an apocalypse. The political party that passed it ran away from it in the next election, and got massacred. But now that it is law, it too is nearly impossible to alter because the alternatives all terrify people.