The answer is not much.

It did not end the government-sanctioned monopoly that the health insurance industry enjoys (and the MLB, those bastards).  It did not take significant power away from insurance companies (it could be argued that this law actually BENEFITS the industry by forcing people to buy insurance).  It did not create a government run health care program, separate from the private sphere.

It DID “give” (make people buy) health insurance.  It DID impose new regulations on insurance companies that were viewed as “ruthless” (pre-existing conditions, age limits, etc.).  But these old practices, now outlawed, were just good business practices for a profit maximizer, but really really bad for the public in general.  That’s what the government’s regulatory role is: to reap the benefits of the free market, and outlaw the ugly tendencies of capitalism.  (It should be noted we DON’T know what the free market would do with these bad practices in this case, since this is a oligopolistic structure).  It should be noted that financial regulation is a great analog here:  if activity is lucrative AND legal, but harms the public at large, it will be widespread (re: financial meltdown).

Why is policymaking so impotent to solve major problems?

The United States Congress is overrun with lobbyists and special interests.  Health care was watered down significantly to pacify Congress’s corporate overlords, and financial reform is toothless.  Again, very simple:  the political system has evolved to require candidates to fundraise with the help of corporate sponsors.  With the new SCOTUS ruling (Citizens v United), corporate speech is more powerful than ever.  Political influence is a zero sum game, the more profit maximizers have, the less the general public has.  Politicians are supposed to be looking out for the public good, not maximizing profits….

steeeeerike.