Why does it seem like a step in the right direction, specifically?
That's not to say there aren't horrible things about Obamacare (i.e. terrible business model) but yes, it's a start.
Neither of those is to say that necessarily Obamacare is the wrong solution but its certainly not the only path.
Insurance is designed to protect the policy holder from an unlikely, catastrophic event they cannot afford otherwise - coverage of everyday costs is not insurance. Notice your insurance company doesn't pay to rotate your tires or change your oil.
Health care, no matter which country you go to, is more of the latter than the former. They aren't primarily insuring against unlikely catastrophic events - that's only a small part of their purpose - they are very obvious ways to spread costs around.
You can't treat health insurance like real insurance, even if they share a name.
They are extremely unpopular for many reasons, which center primarily around paying out of pocket for normal services:
For the purposes of this argument I'm going to use "health plan" to refer to what most people call "insurance" - to avoid confusing the two concepts.
- The out of pocket costs for a no-plan person is extremely inflated. Where your insurance company might pay $60 for a doctor's visit, the cost for someone not on a health plan may be $200-300. This makes the notion of paying out of pocket for routine services unrealistic for the majority of the population.
- These out of pocket costs are expensive because the status quo is for everyone to be on an employer-sponsored health plan. Those who can afford to pay, are on a health plan - the bulk of those who aren't on a plan are financially compromised and likely to default on their debts. This encourages a wild inflation of quoted cost to compensate.
- This further drives people to health plans. Barring the ultra-rich, no one is able to afford health care at "free market" prices, making health plans the only reasonable route forward.
In short, what's wrong with people paying out of pocket for basic services is that "basic services" at market rates will set you back $300 for sore throat.
For example, in some locales you can subscribe to a "direct primary care" practice for a family of four (2 adults, 2 kids) for around $150 per month, and visit your primary care provider as much as you need, paying only for supplies or possibly a token per-visit amount. This, combined with a legitimate "insurance" plan with a high deductible, might set a family back less than half as much as a traditional all-inclusive health plan. (This is what I had in Seattle, with Qliance as my direct primary care provider.)
My son recently needed a physical to start school. As a self-pay patient now located in Denver, I called around to independent clinics in my area and was able to get a fairly good price ($110 total out of pocket, paid up front.) My wife was recently able to be treated for an ear infection for around $80.
If you're actually paying out of pocket it can be a little bit of work, but there are ways to get your costs down to close to "free market" levels.