"Seems that some libertarians (and progressives) would rather things continue as is rather than be changed for the better, if only incrementally."
I don't think these people you allude to actually exist. I've never met a even marginally sane person that would deny wanting to go from their current situation to a better situation. That stated there are tons of differing view of what a "better situation" actually is (such as those that feel a serious depression is unavoidable and would rather start it today instead of starting it after 5 more years of FED powered American Empire building).
Lots of libertarians would agree that establishing emergent medical care as a big "R" right that gov't 100% provides would have huge negative implications for both emergency medicine itself, and additionally would damage other areas of health care that such a president would leech its way into. Agreeing to grant a right to this care might open floodgates of associated or tangential rights once lawyers & judges started using liberal interpretations of the bill.
I think there are many lovers of freedom that look at history and note that freedom is usually lost bit by bit by bit over generations, but won back in watershed moments. These returns of freedom might be somewhat peaceful (think India leaving British rule) violent (American revolution and other colonies rebelling, French revolution ), or the result of gov't unsustainability (collapse of certain ancient empires).
What I've not seen in history was legislating the control away from the government - I mean lets me honest that just sounds insane to even suggest right? We'll have our politicians go to DC and make laws that limit their ability to make laws that control our lives? It won't ever happen.
Thus yes, there are libertarians that want that watershed moment to come (truly massive protest, military generals/soldiers refusing to invade some 3rd world nation, a collapse of federal/state governments, a massive sinkhole swallowing DC into the bowels of the earth, whatever) and they aren't very interested in tinkering with the arrangement of deck chairs in the mean time because the whole system is so corrupt that even bills with the best intentions will either be ignored or perverted to somehow grant more taxes or power.
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