The U.S. Supreme Court will rule soon on the constitutionality of the Patient Protection and Affordable Care Act, the 2010 law that is often called "Obamacare" but just as easily could be called "Romneycare."
America's health care system — if you can even call it a system — is a convoluted mess. Studies show that Americans pay more for health care and get less overall quality than citizens of most other industrialized nations.
Nobody understands our current health care system, and just thinking about it makes a head hurt. Year after year, you pay more for insurance that covers less. You spend more time fighting insurance companies, and you pay more money out of pocket.
We hate the system we have, but we are afraid of change.
It will be interesting to see what the Supreme Court decides, especially if the verdict splits 5-4 along ideological lines. The court's public approval ratings have been falling amid a series of rulings by the court's activist conservative majority. A New York Times/CBS poll this month found that 75 percent of Americans think Supreme Court justices' personal politics influence their legal decisions.
It will be more important to watch how elected leaders of both parties respond to whatever the court decides. Health care, more than any other issue, illustrates today's poisonous politics. Special-interest money, political ideology and unwillingness to compromise seem to have left that concept we used to call "the public good" in the dust.
The main issue before the Supreme Court is the law's "individual mandate." It requires people to buy health insurance from a private company if they can afford to, or pay a penalty to the government to help cover the costs of uninsured people.
Without an individual mandate, almost everyone agrees, a for-profit universal health insurance system won't work. But few people like the mandate, for various reasons. President Barack Obama was against it before he was for it. His Republican challenger, Mitt Romney, was for it before he was against it.
The conservative Heritage Foundation first proposed the individual mandate in 1989 as a way to create a free- market alternative to government health insurance. An individual mandate was part of the state insurance law Romney signed as governor of Massachusetts.
Now, though, conservatives call the individual mandate "socialism." Liberals don't like it, either, because they think it simply props up a fundamentally flawed private insurance system. Many of them would prefer a government-run "single-payer" system, which they say would provide universal coverage with much lower overhead costs and less paperwork.
One way to create a single-payer system would be to open Medicare to everyone. That federal health insurance program, created in 1965, now covers 48 million Americans, most of whom are elderly.
The corporations at the heart of our current health care industrial complex hate the idea of a single-payer system because its efficiencies would cut into their profits — or put them out of business. Republicans and even many Democrats don't like it, either, because they get huge amounts of campaign cash from those corporations.
Thanks largely to health care industry lobbying, single-payer proposals have gone nowhere in recent years. Instead, congressional Democrats passed the controversial law now before the Supreme Court over the solid Republican objections.
The Affordable Care Act will greatly expand affordable coverage and curb some of the insurance industry's worst abuses, such as canceling coverage when people get sick or denying it for pre-existing conditions. But nobody is completely satisfied with the reform law.
In addition to hating the individual mandate, conservatives complain that the law is too complex and won't do enough to contain rising costs. But they have offered no credible alternatives that would provide universal coverage.
Liberals complain that Obama and congressional Democrats made too many concessions to the drug and insurance companies. They say the law amounts to a huge taxpayer subsidy for industry.
But after years of political posturing, Americans need solutions. More than 750,000 Kentuckians have no health insurance, and the coverage most of the rest of us have loses value every year.
Whatever the Supreme Court decides, this is the question each Kentuckian should ask his or her representative and senators: How will you work with members of the other party to create a system that gives all Americans access to good, affordable health care? How will you provide us with access to insurance coverage as good as what the government provides for you?