I can imagine. There would be a disconnect with cost. One side would be trying to minimise while the other want to maximise profits. At least with a public system they're the largest provider around and it's in their best interest to have good outcomes while lowering cost.
I don't want to dump on Obama, because what they did accomplish was incredibly difficult and made things so much better than they used to be, but in comparison with a sensible country (some pretty right-wing, like Singapore) it's ridiculous. And vulnerable as we're seeing tonight.