You know I wish I could believe that this was put into place in order to fail and usher in a M4A system, but I think the reason we don't talk about M4A is because private insurance and large hospital systems don't want it--so it's not even a politically viable option. To me, ACA was meant to be a band aid on a gaping wound (so it was inadequate to start). I think a few progressives thought this would be how we would get to M4A, and honestly, so did I, but after dealing with ACA for 8 years, I think it was private business's answer to what should probably be a public service. We are dealing with a bunch of monopolies (our health insurance companies just keep getting bought out by a bigger guy). It's against their interests to see prices for medical services go down, so if you can't use your benefits because you don't have enough to pay the deductible, it's your problem. Their job was to give you "access" to healthcare, not healthcare. This is what happens when we allow unregulated monopolies to do whatever they want because they pay off our politicians.