The "segue" to which you refer had to be short-hand ... it connected the idea of a preferred single-payer with a perception that numerous people involved in the field held that the political realities of the day did not have a good prognosis for achieving single payer.  Look, one either holds out in the expectation of eventual victory or one fashions a compromise to achieve much more than what we presently have in terms of much broader coverage (available as a result of everyone of any means paying in) and sorely needed limitations on insurance companies provisos.  For me, the ACA was the compromise that moved us further along the healthcare spectrum ... the kind of compromise to which the late Senator Ted Kennedy referred when he opined that he wished he had compromised years earlier when he had the chance to do so with a Repub president.  Similarly, I seem to recall that the Clinton initiative circa 1993 aimed for the total package of single payer (via Ira Messenger), and after that comprehensive proposal went down in Congress following concentrated opposition $$$ showing "Harold & Maude" ads, Ms. Clinton re-worked that single payer concept into an approach like this one ... one that had the better prognosis of surviving, of being real and realized.  It has been about those who have long sought healthcare reform taking yet another look at the lay of the land and moving forward via compromise ... so that forward movement would become fact.

I know one person who has been helped by ACA. She doesn't vote. Never has, never will. Was thrilled to have health care for the first week or two and is now discovering -- good luck finding a doctor who will accept what is essentially Medi-Cal. She's even unhappy with it! And it is bankrupting the middle class to get her what she is being given.

I cannot even begin to describe the degree of vitriol coming from my friends who have actually been responsible about purchasing their own insurance ...

Christine, if you don't listen to another word I say, please hear this. I have NEVER in all my life seen, felt, or heard the kind of all-consuming anger that I am hearing from people now. People who finally, FINALLY thought they had weathered the recession. They're working 60-70 hour weeks now instead of 30-50 they used to, but they've kept their home, they've put their kids through college with a minimum of debt, they thought they had finally made it past the bump, and now here comes Obamacare. Which wasn't supposed to hurt them. Remember that?

My BFF and her husband spent the last four years doing everything they needed to do to keep their home. A year ago they finally thought they were "homefree" (no pun intended). Christine, they are going to now lose their home because of the actions of a Democratic President and a Democratic congress whose leader said blithely,"we'll know what's in it(ACA)when we pass it."

Well, know we know. Another nail in the coffin of the American middle class. Driven in by a Democratic president who had everything he needed to push through Single Payer, except agreement from the insurance lobby and a will to fight for the people who elected him in good faith that he would do so.

MY BFF cannot, simply cannot work any more hours than she is already is. And she cannot afford to triple her insurance for catastrophic only, and still make her house payment. She is one of half dozen people I know personally facing this dilemma, and it hasn't even been law for two weeks.

And these people -- the ones who are paying for ACA? Most are Democrats. They vote. My BFF was Green Party before it was 'popular' to be. She told me this week, from now on she is voting republican. She says she can work and pay her bill under the republicans and she can't do that under the democrats.

You and I can argue the flaws in her argument until we are blue in the face, Christine. But, this is no longer intellectual, nor will it ever be again. I know her. She will not change her mind.

And her employers have already consulted their attorneys and are gearing up to cut worker hours (these are, by and large, good employers, otherwise) to under 30 hours per week before January 2015 when the law for businesses takes effect. I don't even think there will be a penalty for doing this, but they look on the penalty as an 'out.' They can't afford ACA either. It will put them (small businesses) out of business. The penalty hurts them but allows them to stay in business.

This is all so bad from a human perspective. You can twist and turn words all you want. That's all they are: more words. They change nothing. I'm seeing it firsthand, and it is so much worse than I ever thought it would be. And I knew it was going to be bad.

I knew that when Judge Stevens basically said, in the justification of his decision, that it was not the job of the Supreme Court to protect people from making bad voting choices. That was a stunning admission, IMO, but it didn't seem to bother anyone else. And the people tried hard to tell the government how much they didn't want this. Even in ultra-liberal MA, where they had seen first hand the awfulness of it. But people act as if they've achieved some sort of victory because now voters blame the GOP for the shutdown.

What's next? What will our progressive president do next? There's still those pesky weekends and eight hour days, I suppose ...

Increasing America's debt weakens us domestically and internationally.   Leadership means that "The Buck Stops here".  Instead, Washington is shifting the burden of bad choices today onto the backs of children and grandchildren.  

America has a debt problem and a failure of leadership.  America deserves better.

I therefore intend to oppose the effort to increase America's debt limit.

--Barack Obama 3/16/06

She also answered why there was not single payer - there were not the votes for it, which was true. The Democratic controlled Senate includes many Dems who will never vote for single-payer. Same with what was the Dem controlled House at the time. I liked her answer - the ACA, based on private insurance, is being deemed the end of civilization as we know it - what chance did single payer have?