The Supreme Court arguments over the constitutionality of the Patient Protection Act were riveting - good theater for those who care deeply about our American health care system.

But our health care debate is missing the point – all the way to the Supreme Court.

In June, when the Supreme Court has acted, it will seem like we have a new reality:

  • Patient Protection and Affordable Care Act (PPACA) - or not
  • Individual mandate - or not
  • Expansion of Medicaid - or not

But in reality very little will have changed. We will still have the same framework of health care finance – the most expensive health care in the world, with unenviable outcomes to boot. The PPACA is a patchwork of compromises into which we are forced while we evade the real questions. And if the entire act is repealed, there could be enormous disruption to services such as Medicare

It is impossible to find the right answers if we ask the wrong questions. To paraphrase Einstein, a “new type of thinking” is needed … we cannot solve our toughest problems with the same kind of thinking which created them.