When I cast my Senate vote for the Affordable Care Act in 2009, I had a lot of mixed feelings. The bill certainly didn’t do everything I had hoped for, and I knew parts of it would have to be revised by future Congresses. But I was sure that the health-care system we had was broken, and the ACA went at least part of the way toward fixing it.I knew we spent far more per capita on health care than any country in the world, but the World Health Report ranked our system as 37th in overall effectiveness.