No matter what the decision, there will be positive effects for some and negative effects for others, whether this is here in the US, or for someone living abroad. In fact, for most people there would be both pros and cons for almost every law, program or decision. More Americans have access to health care coverage, but it took the federal government getting more involved in the private sector to make it happen. They can reduce the deficit, but I may have to pay more in taxes or endure spending cuts.
If I understand your question correctly, you're wondering about the positive and negative aspects of laws which have been passed ("political decisions"). Obviously, that depends upon the law, as some are beneficial and some are not, depending on one's point of view. One of the grand things about living in America, though, is that we do have options. Say a law is passed, even by a majority, but it somehow violates the Constitution. There is recourse in the the courts, in this case the Supreme Court. Say a law is passed but has some unintended consequences, as many laws do, it can be amended. Or, if we the people don't like what has transpired in terms of laws created and decisions made, we have the right every two, four, or six years (depending on the office) to change our representatives. While the people may have no direct voice in the passing of laws, they do have a voice in passing or failing the lawmakers. Hope that's the kind of political decisions you meant.