I’m no expert, I’m not an overtly political person, and I think about 90% of political debate is bluster and posturing. But I am on the front lines when it comes to health care, and I thought I should share some thoughts on yesterday’s historic decision by the Supreme Court regarding the Affordable Care Act (aka “health care reform”).

There are no easy answers, quick fixes, or purely partisan correctives to the health care situation in America. Government attempts to help all Americans have access to health services, contain costs, and provide excellent care has been a long, complicated process that has been going on for over a century.

• It was former President Teddy Roosevelt who first proposed National Health Insurance 100 years ago in 1912.
• Franklin Roosevelt, Harry Truman, and John F. Kennedy all called for national health care reforms but failed.
• It was President Johnson who finally worked with Congress to create Medicare and Medicaid in 1965.
• Republican President Nixon sought to require all employers to provide insurance and give federal subsidies to everyone else so they could buy insurance.
• President Carter pushed a national health care plan in 1976.
• President Reagan signed the COBRA bill into law which enables workers to keep their health insurance for 18 months after leaving a job, at their own expense.
• President Clinton failed in his attempt to create a national health care plan. He was able to expand Medicaid so that it would cover millions of poor children.
• President Bush signed the Medicare prescription drug benefit, expanding care for older Americans.
• And finally, in the past few years, Congress under President Obama passed the Affordable Care Act.

Most of the people blasting the Affordable Care Act have few alternative solutions, just ideology. Ideology doesn’t cut costs or provide care for the poor and uninsured. It’s time for action.

The Affordable Care Act is very similar to Republican proposals offered during the Clinton administration.

The Affordable Care Act is almost identical to what Gov. Romney did in Massachusetts.

Our costs are much higher in the U.S. than in countries where forms of “socialized” medicine are practiced. A recent report in Reuters indicated that America is highest in spending with regard to health care but only 31st out of 34 countries in the OECD (Organization for Economic Cooperation and Development) in providing care for its people. We are spending $8,402 annually for every man, woman, and child in the U.S.

America does not have the best health care system in the world. Statistics don’t lie. America ranks 27th in life expectancy and 31st out of 40 in infant mortality compared to other OECD countries (see study cited above). With regard to other key indicators, we do not fare well in comparison to other countries around the world. We do have some of the best treatment in the world for those who can afford it.

Half the bankruptcy filings in the U.S. are due to health-care related costs. One study in the mid-2000’s showed that 41% of Americans (79 million people) have medical bill problems or are dealing with medical debt.

Those who worry about not being able to pay for reforms fail to recognize that costs are now skyrocketing and we are all paying for it already. For example, more than 25% of my pay package as an employee (of a health care network!) is spent on health care, and that is just my contribution. That doesn’t include what it costs my employer. And every year, it seems, more and more fees are added here and there which increase my co-payments as well.

Every time someone without health insurance goes to an emergency room for care, you and I are paying for it.

I see ridiculous medical practices almost every week in end-of-life care, which is one of the most costly realms in health care. For example, I watch oncologists and other specialists convince patients and families to undergo obscenely expensive tests and treatments, procedures with horrendous side effects that dramatically reduce quality of life, all for the sake of trying to gain an extra month or two. If most of our patients could have been encouraged to choose hospice just a month earlier, they could have been at home instead of shuttling back and forth to doctor’s appointments, hospitalizations, dialysis treatments, or chemo and radiation treatments. They could have had a team of professionals providing support for both patient and family, helping them reach some of their goals for the final season of life. At a fraction of the cost.

It is estimated that hospitals in the U.S. overcharge patients about 10 billion dollars per year. A personal example: Several years ago, we looked carefully at our EOB (Explanation of Benefit) statements at the end of the year. The charges for our family added up to about $13,000. Another column showed that our health insurance negotiated payments with the providers for about $4000. The charges were three times more than the eventual payments! I’m glad they got the costs down for us, but how many people pay more, or even the full charge?

Personally, I don’t think the Affordable Care Act is the answer, but not for the reason many of its critics dislike it. In my opinion, it doesn’t go nearly far enough. And I’m not sure we’ll ever be able to do more than just take baby steps like this.

We simply do not have the quality of political leadership at present that has the spine to work with others to make hard decisions, call the American people to sacrifice for the common good, and do what’s best for the poor and disenfranchised, and for the future of our country.