I wonder to what extent you and I would agree as to the positives and negatives of the PPACA. My dream ultimately is socialized medicine. In certain respects, PPACA advances toward that incrementally, but for the most part it goes in the opposite direction. Within the framework of our mixed economy, I'm not sure how much closer we could get to socialized medicine, particularly with (1) the firmly-established allowance for states to opt out of Medicaid expansion, and (2) so many ultraconservatives in leadership positions, making decisions based on their ideology rather than concern for the health of their constituents. (There are other roadblocks but that part really irks the shit out of me.)
I tend to believe in a modified single payer system similar to Canadian and British models, with whatever tweaks would be needed to make it work a little better, while allowing a robust private system for those who wish to pay a premium while getting a tax break. I find a strong private system is necessary to bring forward the advances. They don't really happen as much in a strictly government system. It would be two tiered, but life is like that. As long as the normal system is good, it should work out.
Except that the US doesn't have the money to run the ACA. It was initially "funded by figuring ten years of tax increases for four years of ACA". Then the list of exemptions (eg, government payouts) continued to increase. And it's not through increasing, because the goal is political - to create a class dependent on the government for basic health care.
Meanwhile the US runs a trillion a year deficit. You can prattle on all you want about lofty progressive expansions of government service, and of course the vision in your head is superior to whatever you are criticizing. But in the real world, any implemented plan is subjected to corrosive and corrupt influences during its implementation, so your plan, actually is no better or far worse. The deficit and the budget are what will determine outcomes.