"Healthcare is one of his tentative accomplishments which isn't relevant since it doesn't "kick in" right away."

It doesn't ALL kick in right away. My wife got that $250 refund re:the 'donut hole' this year, and will get approximately $2000 in savings next year as 50% of her name brand drugs will be paid by the manufacturer. THAT is a bit beyond a 'tentative' accomplishment, though it will be years before every benefit is available.