Presidential Debate and Health Care

As I wrote in the last post, it's pretty telling that my (unscientific) poll showed that most people are pretty pessimistic about any improvements to the health care system in the US (at least in the near future). This is pretty notable considering the hieghtened attention given to this topic during the recent presidential debates.
Although the economy seems to be trucking along at a decent pace, there do seem to be some pretty ominous clouds on the horizon if one takes into account how broken the health care system is, the mounting national debt (more than 50% GDP) and miscellaneous obligations (e.g., Social Security, Medicare, Medicaid, etc.). I'm no economist, but if this were a household, I don't think it'd be considered too stable.
If the country were a household and the primary bread winner lost her/his job, it'd be in a heap of trouble. A comparable situation would be if China and Japan decided to stop financing our debt by not purchasing anymore T-bills.
This all reminds me of the Jack Nicholson movie with the memorable line, "What if this is as good as it gets?" I mean, we all assume that, eventually, the health care system is going to get better. It's a key issue in the presidential election. Things have to get better, right?
But, what if this is really "as good as it gets?" How pessimistic should we be? Or is there really reason to be optimistic and believe that access to, quality and cost of health care are really going to move in the direction that we desire?