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The Supreme Court decision

By Don McCanne, MD

The Supreme Court Ruling on the Patent Protection and Affordable Care Act

June 28, 1012

Go ahead and wade through the cacophony of responses to the Supreme Court decision. It should be a fascinating excursion through society's exposed soul at its finest, and at its worst. Some of the responses you will hear will rely on refined cognitive processes and others on fundamental reflexive emotions.

You will not hear much new. The sounds will only be louder and more concentrated. Most of you will be able to sort the good policies from the bad policies and identify the special interest sources of the various proposals. Most of us know to keep foremost in our thoughts the only special interest that counts - the patient - with the full understanding that special interests which truly support patients are the ones that we want to pull out of the chaff, leaving behind those such as the private insurers who would serve others using the patient only as marketplace chattel.

We need to continue to guard against the "sound-good" proposals that would seem to move us incrementally toward a high performance system that serves all patients well. By incremental proposals we are not referring to important measures such as reinforcing the primary care infrastructure and expanding the presence of community health centers in underserved communities. Improving the effectiveness and quality of the health care delivery system is a continual process that must always be with us.

The sound-good incremental steps are those that would seem to move us in the right direction but are more like trying to walk up the steep side of a mountain in deep, loose sand. The steps seem to go forward, but the peak is never reached. Yet we will hear pleas to move up this slope. We have been climbing this slope for half of a century, and it's time to look for another route.

Many will plead to keep the glass half full now that the Act has been upheld, while others of us will complain about the glass being half empty. It is time to end this petty fray when we can have a full glass - affordable, high quality care for everyone - simply by enacting a single payer national health program. Call it an improved and expanded Medicare for all, if you will.

(Yes, the Supreme Court ruled that the individual mandate survives as a tax, and that Medicaid is limited but not invalidated. But these decisions have been only a diversion, and thus are included here only as a parenthetical remark. The decisions were limited to an Act that merely tweaks the status quo, when what we need is a new act that rejects the status quo. The Supreme Court does not have the authority to bring us that act. Above all, we must guard against celebrating the fact that the Affordable Care Act was upheld, if that should mean that we would walk away from the reform that we desperately need.)