“Defeat Obamacare” is not a health policy, though you could be forgiven for believing otherwise. Senator Marco Rubio, who is covered under the Affordable Care Act (ACA), quietly inserted a provision in this year’s spending bill that prevents some insurance companies from recouping losses under the shared risk pool agreement. He and his congressional colleagues vow to dismantle the bill, and chip away piece by piece.

But for now, the ACA stands, and Tuesday is the deadline for anyone needing health insurance under the ACA for 2016. Although technically you have until 31 January of next year to enroll, signing up by midnight tonight ensures coverage as of 1 January.

The ACA is far from perfect, but you should use and support it. Despite the valid downsides that some are experiencing, like untenable hikes in premiums and high – sometimes impossibly high – deductibles, the ACA is still an improvement for many Americans over how healthcare used to be.

The number uninsured Americans dipped to under 12% in early 2015 – and most sharply among Hispanic people and lower income earners (below $36,000 annually). Nearly 50 million people, about 18% of the population, lacked health insurance in the years just prior to the ACA. The law has also helped reduce racial and ethnic disparities in access and outcomes.

Recommended immunizations, annual well visits and necessary screenings, like mammograms and colonoscopies, are covered free. For the first time, many are getting care before they get sick, rather than using emergency departments as “fallback” providers. Emergency room care costs the health system millions because it’s the most expensive kind of treatment and, long term, it’s ineffective for preventing or managing disease.

Coverage of pre-existing conditions is a lifeline for many who could never before get health insurance, or opted to go without due to impossibly high cost. Under the law, they can’t be denied coverage, or have benefits limited or dropped. Ask anyone with cancer or the parent of a child with a life-threatening illness, or anyone that’s had to declare bankruptcy to pay off hospital bills, if they prefer “the way it was”.

It can be difficult to think of the “collective good” of the ACA when an insurance company raises your rates beyond what you can afford. However, this supports the entire premise of the ACA – caring for the millions of people who were sick and without insurance and, often, without any care at all. So when they did get coverage, they were already sicker and cost more to care for. And despite the increases, an analysis by the Commonwealth Fund found that for the most part, marketplace plans are affordable.

What’s the alternative? Do we scrap it all and attempt single payer, as Senator Sanders and others want? Some argue it’s a better approach – but as friends in Canada and the UK warn, it’s not exactly the utopia many in the US think.

Single payer is not going to be politically feasible here anytime soon, so it’s best to try and improve on the program we have. Medicare and Medicaid are still being tweaked decades after their implementation. Just this fall, Medicare agreed to start paying physicians to discuss advance care planning and reimbursing for more telehealth services. Change is part of the process.

The Affordable Care Act itself included roughly 165 provisions to improve Medicare’s finances. Medicare expenditure projections have dropped significantly, which means relatively lower out-of-pocket health costs for current and future retirees.

Healthcare is by definition imperfect because it’s never a “one size fits all” solution. Everything from medication management to patient compliance to provider testing drills down to an individual level. It also underscores why healthy individuals must participate. Spreading out the risk pool ultimately lowers the cost of care for everyone.

It’s no stretch to anticipate, should Obamacare go, a return to emergency rooms clogged with patients using them for primary care, healthcare costs again creeping up and lower wage earners going without care because it’s too expensive.

If the ACA is really so horrible, then let’s hear a better plan. It must be one that will get all of the stakeholders on board, and cover everyone, and cut costs and improve outcomes and be affordable. And, get it done in the first two years of the next administration.