Akst: After court decision, health care is a mess, but not a shame

Well that was close.

As everybody no doubt knows by now, the Supreme Court upheld the centerpiece of President Barack Obama's health care reforms, validating the constitutionality of its requirement that everyone carry health insurance or pay a penalty that the court said is really a tax. This "individual mandate" started life as a pretty good Republican idea, but became radioactive to the GOP when Obama took it up. It's more or less the same system Mitt Romney put in place in Massachusetts, where it works fairly well.

In my view it would be far better to cover everybody under Medicare and call it a day. I'd even hoped that, if the Supreme Court struck down all or most of Obamacare, we'd get to a single-payer system sooner.

But for all its warts, the complicated and ill-understood plan that Obama and the Democrats have given us is what we're stuck with, and it's a lot better than no plan at all. Most of America's 46 million uninsured will be covered, thanks in part to government subsidies for those who can't afford insurance on their own. People who've had cancer or some other serious disease will no longer be shut out of the insurance market. Amen.

Opponents of the plan ought to bear in the mind that it's not the big deal they seem to think it is. Government at all levels already covers about half of U.S. health care spending; the economist Christopher Conover, for instance figures that, taking account of tax breaks, governments pay for 53 percent of our medical costs. We also way outspend any other country in the world on a per capita basis or as a proportion of gross domestic product, even though we fail to cover everybody. It's a tragic fact that nearly every American under age 65 faces the risk of bankruptcy from medical bills, or death from lack of care -- a situation that prevails in no other comparable nation, to my knowledge.

These are the big issues: overspending, poor health outcomes, no coverage at all for millions, and insecurity for all. The Obama plan won't solve all of these problems -- not by a long shot -- but it's way better than nothing. Bad enough that American health care is a mess. It needn't also be a shame.