Here's the problem with the ACA. It's simple.

[Donald Ian Rankin]

32. The problem is the absence of state healthcare, not the presence of insurance companies.

As far as I can tell, there's not all that much difference between insurance companies in the US and here in the UK.

But here, it's entirely clear that they're a sophisticated form of bookmaking, not a social service; the entity with responsibility for caring for the sick is the NHS. They're trying to make a profit in an entire legitimate business, and there's nothing unethical about this; it doesn't cause problems because people who aren't happy with what's on offer from the insurance companies can still get perfectly good health care on the NHS.

In the USA, however, you've devolved what should be some of the responsibilities of the state onto private businesses, which are there to make a profit, not to provide a social service - and you're then angry and in some cases bewildered when this doesn't work, and they don't fulfill those responsibilities.