By relying on private enterprise more than any other developed nation, American health care has all the appearances of free-market in action. And for more than a hundred years, attempts to reform this system (including President Obama's Affordable Care Act) have been met with opposition from parties warning against the stifling effect of government intervention. What these warnings about federal overreach overlook is the fact that the federal government has long been an indispensible player in guiding and supporting the current US health care system. Its role is so pervasive and of such longstanding importance that it is easy to overlook, but it actually created American health care as we know it today.