Through the Industrial Revolution medicine increased in scope and complexity and cost. By the 1970s people expected access to hospital care which was increasingly expensive to provide. Around the world most developed nations came up with some kind of universal insurance or single payer system to handle this. The US went with employer based care which limits who is covered and puts a burden on business.

Ongoing calls for universal basic care threatened market based care in the US, so Mitt Romney came up with a plan to provide universal care through government regulated insurance markets. Obama tried to bring this plan to a Federal level but was stopped by a complex array of social and political forces. As a notable example of what happened, Frank Luntz who often has interesting ideas to contribute to this day insists that the ACA was not an insurance program even though providing health care through private insurance was the central concept.

So now there are people who see the ACA as a compromised attempt to save market based insurance provided medical care and others who see it as some kind of strange intervention amounting to socialized medicine which oddly enough is exactly what it was designed to avoid. Where ACA was adopted it seems to be working reasonably well, and in Massachusetts where the original Romney plan was adopted everyone is insured and gets care through private insurance markets coordinated by the government.

The really big irony here is that by compromising ACA and then not even adopting it in some states it is increasingly likely that some kind of Single Payer system will end up being adopted at a Federal level. In this sense those who attempted political intervention have generated the most harmful possible result. That is the increasingly likely possibility that the existing system of providing health care in the US through insurance markets will be completely swept away instead of being reformed as Mitt Romney and Barack Obama advocated.