I once heard my niece...

...go on and on about the shortcomings of her health insurance company, blaming it all on "Obamacare." (She said it as if the Affordable Care Act was some sort of "government takeover of health care.") And I thought, "Isn't your complaint really with the American health care system?"

I was reminded of that yesterday when reading an opinion piece in the Times, "Sorry, We Don’t Take Obamacare: The growing pains of the health care act are frustrating patients."

First of all, it's important to remember that there's no such thing as "Obamacare" (unlike "Medicare" here or in Canada). The goal of the Affordable Care Act, as the piece concedes (all emphasis mine):

...which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage. It has also created a host of new policies for self-employed people like Ms. Moses, who previously had insurance but whose old plans were no longer offered.

Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent.

That's right: without the ACA, many self-employed people (like my wife and me) might not have health insurance. Were we thoroughly pleased with my employer-provided health insurance before? Of course not. Every year, it seemed, it got more and more expensive while it covered less and less. (And wages stayed flat. Is there any connection there?)

The title also refers to "growing pains."

Many of the problems may well be the growing pains of a young, evolving system, which established only broad standards for A.C.A. plans and allowed insurers — a large majority of them for-profit — considerable leeway in designing their exact offerings. The specific requirements and policing mechanisms vary by state, and are still works in progress.

The ACA, like any law, will be fine-tuned over time. In fact:

Across the country, lawmakers and regulators are refining the plans’ requirements to make sure they work better.

The piece then circles back to its original point:

The research thus far suggests that the differences between plans offered through the A.C.A. and those offered by employers may be quite significant. A study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan — the most popular choice — as they were in the average employer offering.

Remember, the ACA plans were created for people who didn't get their insurance from their employer. In many cases, these individuals didn't have access to insurance at all.

There are essentially two things we could do about the ACA. First, repeal "every word of it" as candidate Ted Cruz would do. But that would be kind of foolish, wouldn't it? (People forget that health care reform was the most pressing domestic issue in the election of 2008 before the financial collapse in the fall.) No, we can't go back to the old system that left so many people uncovered.

The second thing to do would be to work with the ACA to make it better.

My guess is that the American health care system will look more and more like Germany's: everyone will have private insurance from cradle to grave that's heavily regulated by the government. Every doctor and hospital will take everyone's insurance because they will all look the same. If you can't afford it the government will subsidize you. Insurers will resemble public utilities and compete on service rather than price. Since we can't get around the private insurers, we'll simply achieve a de facto single-payer system "through the back door." It's not pretty, but it's the only way.