I can see what you're saying, but I'm not talking about marginal improvements for the vast majority, or vast improvements for the vast minority. I'm talking about large, systemic improvements.

The issue with electoralism is that the right candidates cannot make it to the ballot in the first place, the system weeds them out.

I'm not defeatist about voting, I think loss prevention is crucial. I'm not naive though, voting won't ever fix our society, that must be done at the grassroots level.

While I don’t disagree, the individual mandate was a crucial part of making it work, and also the weakest part of it. There shouldn’t have been an individual mandate without a much larger medicaid supplement or Medicare-for-All as options. A handslap fee for not having insurance was both a worthless penalty and legally shaky from the get-go.

There should’ve been caps on premium and deductible increases that were way more realistic, too. Like rent-control and tied to either a maximum percent of net profit increase, or inflation, etc.

Ultimately I don’t think Obamacare went far enough, and I don’t think there’s an argument to the contrary that’s not in favor of protecting the true enemies of sustainable healthcare, the insurance companies.

Not sure I agree. I think many people who are "defeatist about voting" have observed that the surface-level differences between Democrats and Republicans (namely social issues and the more visible fascism from Republicans) just mask an underlying corporatist/fascist state that's sacrosanct and immune from popular pressure and legislative change.

Re: "Obamacare" (which is just one tiny change mind you) - there were some marginal improvements like re: preexisting conditions, but mostly it seemed to increase compliance costs, my understanding is premiums have just continued rising and the fundamental issues causing healthcare scarcity and limiting competition have been made worse.