The "abysmal" results are primarily due to the nonuniform access to healthcare services. OCare has taken a step towards that but there are still too many uninsured and unable to access healthcare services except on a a rare or emergency basis. Widespread health maintenance plays a large role in the climbing out of the abyss:
"Timely and accessible health care could mitigate many of these challenges, but the U.S. health care system falls short, failing to deliver indicated services reliably to all who could benefit. 3 In particular, poor access to primary care has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies, and coordination and safety problems."
Same link.