Here is the best explanation for why for 75 years presidents have been "unable" to pass health care for Americans:
"The usurped power of the party oligarchs, perpetually threatened by political liberty, can only be maintained through a ceaseless effort to discourage the exercise of that liberty. The party oligarchs must perpetually try to demonstrate anew that politics is futile, that politicians are powerless, that public hope is public folly, that whatever is must be, that whatever happens is inevitable, that every citizen's real enemy is the citizen next door. That is why the opportunity to spend billions of dollars yearly on improvements of benefit to all is not an opportunity but a peril to the oligarchs."
Walter Karp, Indispensable Enemies, p. 281.