Emeritus Prof Ted Marmor, of Yale University, a public policy and political science expert, said President Barack Obama's health reform was not overly ambitious, and amounted to "Republican-style health reform" by subsidising private healthcare.
During related debates, practically no mention was made of British or European-style universal healthcare, as it would likely have whipped up even more of the ideological fervour which accompanied healthcare changes in the US.
In attempting not to rile his opponents, Mr Obama struck a "quite dangerous and quite weak bargain".
The crux of the reforms was subsidising healthcare insurance so more people could afford it, and tightening the regulation of insurers.
More than 50 million Americans have no healthcare insurance, and health expenses are the second most common cause of bankruptcy in the US.
Prof Marmor said the Administration postponed the most expensive parts of the reforms to later years, which could easily be shelved if Republicans came to power in 2012.
The existing healthcare social-assistance programmes, with provision for the old, the very poor, war veterans and the acutely ill, made up a patchwork providing for those most in need, he said.
Passed in March, the reforms were a "patch on the patchwork of medical care".
Although it was an achievement getting them through Congress, the reforms left most Americans confused about what they actually meant.
His preference would have been to increase provisions for assistance programmes like Medicare and Medicaid in the meantime, and then wait for better economic times to pitch a social insurance model.
It was wrong to blame powerful insurance or medical lobbyists for resisting more thorough reform - the powerful institutions of state which diffuse power, the Congress and the Senate, along with political games such as filibustering, meant it was very hard to push changes.
Prof Marmor said, while the US had a strong "almost libertarian" streak, its voice was amplified by shrill broadcasters like Fox News.
Journalistic objectivity was a problem, because going to each "side" of a debate rested on the view the truth must be in the middle, even when dealing with the "craziness" of the extreme right wing.
Healthcare was the biggest industry in the US, worth $US2.5 trillion ($NZ3.3 trillion) last year, which was 17% of gross national product.
