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.