While analyzing the contentious debate over health care reform, this much-needed study also challenges the argument that treating medical patients like shoppers can significantly reduce health expenditures.• Explains why the two political parties have staked out such different positions on health care reform• Documents what the public knows about the Affordable Care Act and how individuals' party identification significantly affects their knowledge• Challenges the arguments for consumer-driven health care plans by gathering evidence from numerous studies of consumer behavior under various kinds of insurance plans• Offers a well-informed critique of the political arguments surrounding the expansion of Medicaid, showing how this policy diffusion leverages the weak arguments and evidence for consumer-driven health care plans