Prologue

One arm of US governance passed a partisan Bill called Affordable Care Act (ACA). Y'all remember the 1½ yr fight over this; and when Nanci Pelosi said sign the damn thing and then read it late (like a lot of US legislation). The Administrative arm - The President - signed this Bill into law. He made this a 2008 campaign issue and so the Bill became known as Obama Care. 26 States Attorneys-General(I think they're all Red states, that is, the Legislature or Governor is a Republican) asked the Supreme Court to listen to several arguments and specifically about the constitutionality of the Individual Mandate. If the Supreme Court strikes this down (based on the Interstate Commerce clause), then the ACA will probably fall apart. The President, BTW, could have postponed these hearings till 2013, until after the November 2012 elections, but win or lose, Obama feels this would be politically advantageous to his re-election chance.

The Philosophy

The Republicans approach to, not only this, but to governance in genera, is to "starve the beast". You see, when the govt doesn't have money it can't spend. If it can't spend it can't tinker with society and it means it is not in the way of individual pursuits. The Republicans focus on the Supreme Court case is "the Federal Government over-reach". Government can't run anything; they're already a participant in over 50% o health care spending. And they're probably right at one level.

The Democrats see health care as a policy - it is too costly; health care premiums doubled from 2000 to 2008; 30 to 40 million Americans are uninsured not because they chose to but because it is unaffordable; and there are many things wrong with medical care delivery.

So the difference is clear and there is a choice.

The Economics

Both sides believe that if everyone is an economic participant in the health care industry the risk pool becomes actuarially more manageable and insurance premiums become less costly. The liberal wing of the  Democrats has always advocated a single-payer, and the Republicans countered with the market philosophy of individual accountability, hence the birth of individual mandate by t Republicans and pushed by Nixon, Bob Dole and recently Mitt Romney. Obama sided with the Republicans and suddenly it is government over-reach. You may say that Obama's hands must not be the midas touch for republicans - because he's Democrat or if he had a son he would look like Treyvon Martin? (that’s the black kid shot in Florida last month using Florida State’s “Stand your Ground Act”.

Both parties want to end Insurance companies denying coverage because of pre-existing conditions. Obama Care is implemented over time. The 2 million plus kids who get their parents' coverage until 26 and the kid who has asthma or is diabetic get coverage now. All Medicare recipients have already saved over $2 billion. These are in effect. It is the individual mandate that will come in being in 2014 that's the crux of the Supreme Court hearing.

The Supreme Court

It has recently been an activist body - intervening more than playing safe, and the money is that they will apply the Federal constitution narrowly. But I have an optimism that they will say, we can't rule on something that isn't in place yet, and give Obama Care a stay of execution until after the 2012 elections. Maybe this is what Barack old buddy strategized. The other hopeful deliberations by this august body will be that health care is a commodity unlike any other (including the infamous broccoli). Everyone is a participant sooner or later and given the 20% economic impact, by paying later than sooner the individual is influencing market price. You see the Federal government mandated that Emergency Rooms cannot turn away a sick or injured person because he or she doesn't have insurance. This is a key consideration for the Supreme Court - the separation but yet inter-connectivity of health insurance on the one hand and health care delivery on the other.

Obama

Whatever the Court ruling, Obama has changed health care in America in fundamental ways. Republicans are right to argue that once an entitlement is enacted it is difficult to stop it from growing or roll it back. This is why they don't want Obama Care to become the social security story 40 years from now. That's a precedent in the Inter State Commerce law that I'm surprised Obama's legal team did not advance much of. The approach of preventative care, pay for service and not procedures, millions now getting coverage, College kids on their parents coverage, etc. These are pluses for Obama Care in the 2012 elections.