If you believe that such a large program would just start up without problems, then you are indeed deluded. This would be so even in private industry! But, it does not mean that the program itself is a failure, it needs both work and some time. Something that the tea party types are not willing to do, as they do not wish to just modify the program as it goes along for greater efficiency, the just want to kill it without even having ANY kind of replacement at all.<p.
And of course our current program is so good. It is rated as the 38th best in the world by the world health organization, we are right behind that great industrial power of Costa Rica. But we are number one in one area, ours is the costliest in the world. So, I do not see just how we can get much more costly than that with the ACA program!!