I'd have no problem with an actually centralized single-payer plan. However, the ACA is shoehorning private, for-profit insurance companies into the middle of

I'd have no problem with an actually centralized single-payer plan. However, the ACA is shoehorning private, for-profit insurance companies into the middle of this, all the while constraining them and driving everybody's costs up by approximately 3x to most observations I've seen of myself and others. To properly implement a government health care system would be to effectively destroy most if not all the for-profit insurance companies* and set up a system with a mandate for national health. Nobody's going to want to do that, politically. * = Having a central system covering a lot of the basics, and insurance companies to provide "upsell" coverage could still exist, but those insurance companies would likely not be in the same ballpark of financial movement as they are today.