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Five years ago, U.S. President Barack Obama and his Democratic Party had a crazy idea that maybe the richest nation in the history of the world should do something to make its fragmented, inequitable and very expensive health care system a little better.

So you Yanks finally got around to establishing universal health care? Welcome to the mid-20th century!

Thanks, but that’s not quite right. Even after the Affordable Care Act is more than a decade old, there will still be 31 million people who don’t have health insurance. That’s 25 million fewer uninsured than there would have been without the new law, but it’s still a lot of people. Undocumented immigrants are left out of the health insurance exchanges and Medicaid. Some Americans can’t afford insurance even when it’s subsidized. Others will simply go without and choose to pay a tax…

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