Obama knew when he was elected that he was seen as an inexperienced politician in the national arena. So he decided to allow the Congress to write his health care legislation. In the times of Kennedy, this would probably have worked. But the country is too polarized for that to work now. The US system of government is DESIGNED to make change very, very difficult. In a European country, as in Switzerland, for example, a majority wanted a national healthcare system and the people voted in those who favored it. A much smaller country with less divisions according to political sentiments, they managed to pass legislation in several months. Now most Swiss like it and there is little sentiment to remove it.
The US system is antiquated and designed to produce dissent and eternal debate. Like California, the US is becoming ungovernable because the system itself is defective and unfair. For example two senators represent some 600,000 people in Wyoming, and they have as much influence as the two senators that represent 16 million people in California.