Last week the liberal documentary-maker Michael Moore prompted indigestion across the progressive wonk community by pronouncing Obamacare “awful.” In a New York Times op-ed, he bemoaned the way the president’s law preserved the health insurance industry rather than replacing it with a Medicare-for-all style single-payer system. The good news, Moore conceded, is that the previously uninsured (and often previously uninsurable) can get finally get coverage. The bad news is that their coverage will often be lousy and pose an enormous financial burden. He ended by calling for activists to lean on state politicians in an effort to beef the law up.

I happen to agree with Moore’s basic sentiment. For-profit health insurance is on some level morally offensive—at least when it’s practiced the way we Americans practice capitalism. With a few tantalizing but mostly unrepresentative exceptions, the longstanding aim of health insurers has been to weed out sick people, and to weasel out of paying for treatment if they somehow get insurance, so that the companies could boost their share price, lavish income on their executives, and plow money into annoyingly saccharine TV ads. To its everlasting credit, Obamacare genuinely tries to whip the insurers into shape—making it illegal to deny coverage to sick people, or to withdraw coverage when healthy people get sick, among other much-needed reforms. But you still have to be skeptical of middlemen who historically spent a mere 60 cents of every dollar individual policy-holders sent them on, you know, health care.

And yet I’m still much more sympathetic to Obamacare than Moore. He thinks it’s awful. I consider it a deceptively sneaky way to get the health care system both of us really want.

How? Allow me a brief digression: In 1991, Congress created the National Breast and Cervical Cancer Early Detection Program, which funded screenings for women who earn up to 250 percent of the poverty level. What Congress didn’t do is provide money to pay for treatment if the tests came back positive. The policy seemed sadistically cruel: Suddenly thousands of women would discover they had a life-threatening illness while realizing they could do nothing about it. Both Moore and I would have surely denounced the law. But it soon proved to be a shrewd, if unintentional, opening move. “Almost from the moment it was implemented, there was pressure to take the next step,” says Harold Pollack, a professor of social policy at the University of Chicago. “They constructed a sympathetic and organized constituency … with an actionable grievance.” Congress approved the money for treatment in 2000.

In some sense, Obamacare is the breast-and-cervical-cancer story writ large. In order to move the law through the Senate, the White House had to make all sorts of noxious compromises, like keeping the overall spending under $1 trillion, which limited the subsidies available to people buying insurance. Hence the kind of horror-stories Moore cites in his op-ed: A 60-year old couple with an annual income of $65,000 who could end up spending $25,000 on health care in a single year. And that’s with Obamacare. (This is something of an outlier, but not that much of one.) But the flip side is that the law also created potentially millions of hard-working Americans who will have some health insurance; just maddeningly insufficient health insurance. What are the chances politicians stand up and take notice when these Americans complain?