My heart leaped upon hearing the SCOTUS decision on Obamacare. The U.S. Supreme Court upheld the central components of the Affordable Care Act (ACA). This decision, a huge victory for patients, offers a message of hope -- one that's relevant not just to politics about medicine, but to the practice of medicine. Chief Justice Roberts demonstrated that one person's out-of-the-box, thoughtful approach to a complex problem can change an outcome and save lives.
The decision offers hope at three levels. First, it's relief for patients. If you have a pre-existing condition, the ACA will help you by making insurance more affordable. And if you should suddenly become sick with leukemia or suffer trauma in a bus accident and need care, this law will make it likely that if you're in the United States when that happens, you'll have access to modern treatment provided in a manner that's respectful and won't cause bankruptcy. Among other things, this law means you needn't be a beggar just because you're sick, and so it affords greater dignity to people with illness.
Second, it's an example of a surprising outcome. That sometimes, even when you think a tide, or the stars if you believe in those, or some kind of group-think wisdom has turned against something you value, the situation can improve, suddenly and in a way that you hadn't previously considered possible. This message gives hope to people in all sorts of seemingly-gloomy circumstances. Think of a prisoner with an undue life's term, who might be released by a governor's change or heart or reason. Think of a patient, whose doctor looks up yet another treatment option that no one had previously considered. Improbable, even unthinkable things happen occasionally, as they did this week.
Finally, and here's the thing that most affects me about this decision, is that it shows how smart people -- with whom you may not necessarily agree -- can make a positive difference and do the right thing. Like pretty much everyone, I didn't anticipate Chief Justice Roberts' position on the individual mandate. His decisive, clever and bold move changed the outcome of the SCOTUS decision. His willingness to listen, to think, and to put himself out there -- at certain risk of colleagues' criticism -- is the kind of morally-grounded stance we could use more of in politics, medicine and other professional fields.
In medicine, I wish more experienced and senior doctors would be willing to try this kind of considered approach to people with complex illnesses. Consider a young patient with a tough kind of lymphoma, or a rare and progressive neurological condition. Some doctors would throw up their hands and say "there's nothing that can be done." They'd cite old, published papers, and reconcile themselves, and the patient, to a hopeless situation. Only a few, with experience and insight, might search so hard for a solution, or even a possible solution, that's unconventional but deliberate, informed, and in keeping with the rules.
Chief Justice Roberts did just that. By his careful thinking, and what musts be a profound sense of responsibility, he made all the difference in the Supreme Court's decision. He'll have saved countless lives. Kudos!
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