This kind of concern trolling seems to ignore the idea of loosely coupled nation states which have already implemented a variety of superior health care systems. Costs less, their people are more healthy. What I like to call "existence proofs". Just because ACA is a terrible idea for one nation doesn't mean that sole implementing nation should then hide behind exceptionalism (NIH) or weird textualism legal constructs and pretend what meager progress has been made so far is in some way radical.