THE TRUE impact of the Supreme Court’s decision on President Obama’s health care law won’t be felt on the high court or the presidential campaign trail: In each arena, the status quo more or less prevails. But the court’s approval of the legislation, the first attempt at comprehensive reform of the sprawling health care bureaucracy, is a landmark event nonetheless. It preserves a crucial framework for wrestling with issues of cost, access, coverage, and quality that would have been completely lost had the court’s activist conservative wing — which sought to derail the entire enterprise — carried the day.
The law, in itself, is not a panacea. The court’s ruling may hamper the expansion of Medicaid, a key way in which the law offers medical coverage. Other provisions, like the medical-device tax, will also need to be rethought. Still others, such as the penalty for working adults who decline to carry coverage, may have to be adjusted over time. The best-practices data that are useful in controlling costs must be properly applied. Cost savings, such as those from the computerization of records, must be tabulated.