I ask all you Obama doubters out there..

[Jim Lane]

68. The National Environmental Policy Act (1969 -- signed by Richard Nixon)

As for the ACA, I think it's too soon to tell whether it qualifies as a genuinely progressive change.

Calling it a "health care" law is a misnomer. I always call it a "health insurance reform law" or the like.

It works some significant improvements in the system that relies primarily on private, for-profit health insurance companies. It also compels everyone of pre-Medicare age to patronize those companies. (OK, not everyone. Some people have access to insurance offered by not-for-profits. Some people will choose to pay the fine instead of buying the insurance, and some of them will be making the correct decision. The point is that the ACA will push millions of people into patronizing for-profit companies.)

In terms of actual health care, as opposed to merely insurance, many people will get care in 2014 who would not have gotten it without the ACA. There will be some who will get worse care because of the ACA, but the overall effect in 2014 will be positive.

A big potential negative of the ACA is the danger that it will further entrench the worst features of the current system (health care paid for through for-profit private companies, with insurance delivered primarily through employment). I believe that the United States will eventually have some form of single payer, but there is a strong argument that passage of the ACA will turn out to have delayed that day.

Obama "doubters" (as you call us) can also point to a different comparison. Instead of comparing ACA with no bill at all, some of us compare the actual ACA with what might have emerged if Obama had acted differently in some respects. No, he couldn't have gotten single payer through, but by being less ready to compromise he might have gotten a bill with a "robust public option" (his own stated minimum requirement, IIRC, later abandoned) and without some of the concessions to Big Pharma and the like. There's no way for Obama "doubters" or the other side (Obama cheerleaders?) to know with certainty what would have happened in this hypothetical.