The ACA was, I believe, a highly intentional better-done-than-perfect effort, fully cognizant of the historical cycles of political will around major healthcare policy in America. If you review in depth the efforts in the 90s under Clinton, and earlier under Johnson, I think the approach was well considered. A more ambitious policy proposal ending in failure very well may have have put the topic to bed for another twenty years. The loss of the “public option” did sting, though.