Undoubtedly a very high percentage of the public favors fundamental healthcare reform — the problems and objections that plague American healthcare are longstanding. The trouble comes with the details of proposed solutions. As with any problem, people want answers but shrink from the costs to themselves those answers bring. Other advanced democracies, in the wake of the disruptions of the mid-20th century (social, political, physical, and economic) were forced long ago by severe circumstances to move firmly in the direction of rationalized universal healthcare systems that, over time, have been very successful in terms of cost and public health results. The U.S., much wealthier than the others and spared all of the worst disruptions, evolved a complex, non-rationalized system that satisfies most but conceals enormous costs and leaves a large number of people without coverage. Now interests of all kinds are firmly entrenched and we are betrayed by our own success into a trap of costs that are unsustainable and social disparities that even many Americans (never mind Canadians and Europeans) find barbaric. It is ironic, frustrating, and — given the power of the interests involved — incredibly difficult to escape. On the personal level, most people are happy with their care and deeply wary of anything that might disrupt it, even as they readily agree that the system is an unfair, expensive mess that needs to be changed. Barring changes that will clearly benefit them, (or people like them) or at least clearly leave them alone, they recoil with caution and worry from any actual reform. And so the problems keep getting worse.

Healthcare is not the only place you see this, and Conservatives must face it as much as Liberals. As the Republicans have discovered, overwhelming majorities want the federal budget balanced, but woe betide anyone who attempts changes to the entitlements on which middle class voters rely.

It is ever thus. The true villain in these persistent problems has a name, and he is called The American People.

The poll also shows that the partisan divide remains as high as ever. This leads me tp share your tentative conclusion that the Justices will most likely vote on party lines. However, it also suggests that overturning Obama care cannot help but make the Supreme Court, and particularly the Republican judges, even less popular than they already are. Thus, in a perverse twist, overturning ObamaCare may actually help the President get reelected.

If the Republican judges understand this, they, and their party, might decide that they will be better served if they were to avoid the backlash by upholding the mandate and take a chance on winning majorities in both the House and Senate in the next election. But that’s probably too subtle!

We have come a very long ways from focussing on how good government should really work!

George