Obama knew it was flawed, but it was the best he could accomplish given the power of the insurance industry over our legislators who never cease bending over for them at our expense. He pushed it through as is because it improved things for many people even while it made things worse for middle-income families. That making things worse is ugly for those of us it hurts, but Obama knew that it  will be what finally pushes this country past the propaganda fed to us to keep us enslaved to the insurance and pharmaceutical industries. When we are devastated enough, we will finally wake up and join the rest of the world in improving our healthcare payment system for all of us.