Affordable Care Act needs some tinkering.

The rollout of the Affordable Care Act is a month old, and it's winning few friends while attracting a lot of critics. The logjams at the website for choosing an insurance plan, the cancellation of policies that fail to meet the ACA's requirements for minimal coverage, and the realization that the costs may be greater than expected all suggest that the ACA needs some tinkering under the hood to get it running smoothly.

Unfortunately, no one is talking about making adjustments. Republicans, especially those in the House of Representatives, who have voted dozens of times to repeal the ACA, are not in a mood for tinkering; they want nothing short of demolition. Democrats, at least most of them, insist that the law is fine just the way it is. They fear that giving in to demands for changes will open the floodgates that will allow the Republicans to sail through toward demolishing the act. President Obama has said he is willing to consider changes, but at the same time, he has denied that changes are needed.

Since the 1990s, I've thought that a national health care plan made sense. American health care is far more expensive than in any industrialized country in the world. Prices keep rising exponentially, and only the health care conglomerates, pharmaceutical companies and insurance companies seem to be happy with the system. The ACA sought to mollify the insurance companies by keeping private insurance as the payer in the system (instead of a single-payer system like Medicare) and to mollify the health care industry by not pushing too hard on pricing. On top of that, the act included provisions to attract voting blocs, particularly women, with free contraceptives (not even a co-pay) and mandatory maternity coverage. Little was done about efficiency and effectiveness.

I still think a national health care plan makes sense, but it's obvious the ACA needs revisions. Unless those revisions are made, the electorate could turn against the entire program, and health care would revert back to where it was, with the pharmaceutical, hospital and insurance giants ruling the country.