What is a pipe dream? The system that every other first world western nation has? I used to work for a British tech firm. Yes, their system has problems. They know it. None of them ever wanted our system.
You are right about opposition from the insurance industry. The entire reason why the ACA did not have a public option was meant to get around that opposition and to get GOP support. It did neither, and it is part of the reason premiums are as high as they are.