The 2010 U.S. health reform legislation: Evaluating the experiment

Abstract

In the early part of 2010, the United States Congress enacted, and President Barack Obama signed into law, the Patient Protection and Affordable Care Act (PPACA) [18]. This massive (more than a thousand pages) piece of federal legislation purports to reform the entire American health care financing and delivery enterprise in ways that will demonstrably improve the quality of health care and its accessibility and affordability for the populace. In widespread public debates and private arguments about the PPACA, both while a multitude of different versions were under legislative consideration and since enactment of the final Act, contrasting claims have been made by proponents and opponents regarding specific projected results of the Act’s passage and implementation. Even though (shamefully) members of Congress openly (in some cases almost proudly) admitted that they had not read, and did not know the contents of, the bill upon which they were voting, legislators on both sides of the aisle were influenced – to whatever extent they were not driven by pure politics – by their respective assumptions about the specific salutary or deleterious effects that they expected to emanate over time from the changes made by the PPACA. In many respects, the a priori assumptions of both PPACA advocates and critics rested more heavily on ideological faith and gut instinct than on carefully informed reasoning. As elegantly enunciated by an official of the American College of Physicians: