It would seem that the majority on the US Supreme Court is conflicted about how to respond to the healthcare reform currently known as "Obamacare."
CNN's legal correspondent Jeffrey Toobin  listened to the high court's deliberations this week and concluded that "this was a train wreck for the Obama administration. This law looks like it's going to be struck down."
Not so fast, suggests the Wall Street Journal, which like most media pins the outcome on Justice Anthony "Swing" Kennedy. "Justice Kennedy's early comment that the government carried a 'heavy burden of justification' showed considerable sympathy for the challengers," observed the Journal Tuesday . "But toward the end, one of his questions suggested that people who don’t carry health insurance are still engaged in the healthcare market—which is the central pillar of the government's case."
It's all so confusing. Or maybe not.
It is obvious enough that the barely cloaked political partisans who dominate the court would like very much to whack the Democratic president  by declaring that critical components of his Patent Protection and Affordable Care Act —or, to borrow Vice President Biden's technical terminology: Barack Obama's "BFD" —are unconstitutional.
By the same token, the justices know that their conservative movement's paymasters in the insurance and healthcare industries, and on Wall Street, are actually looking foward to the day when the government requires Americans to purchase insurance from for-profit insurance companies , and when Washington steps in as the guarantor of payments to those companies (and to for-profit healthcare concerns) on behalf of low-income Americans.
Tough call, indeed.
It is usually smart when such conflicts arise to bet on the corporate crowd, as they really do call most of the shots.
But on the outside chance that the court goes rogue—as some analysts are suggesting after two days of hearings on the plan that was approved by Congress and signed into law by the president—is that the end of healthcare reform?
Frankly, it could be the beginning.
It is not like a decision by the Supreme Court to scrap all or part of the current plan is going to make the crisis facing America's dysfunctional healthcare "system" go away. In all likelihood, it would cause the crisis to become even more of, well, a crisis.
By the same token, allowing the Obama plan to go forward in its current form—without the protection that would have been afforded by a public option—is not going to solve nearly as many of the plan's problems as its more starry-eyed proponents might imagine. Indeed, one of the selling points for the Obama plan when progressives were gritting their teeth and deciding to support what was clearly a compromise was the understanding that the Patiet Protection and Affordable Care Act was a beginning, not an end.
The end has always, and should always, be the single-payer "Medicare for All" plan  that would provide quality care for all Americans—as a right—and cut costs by eliminating the profiteers.
So how, amid all the legal wrangling of the moment, should real reformers think about things?
“Whether the Court overturns part or all of the law, or the Affordable Care Act remains fully intact, we will not have universal coverage, medical bills will still push too many Americans into bankruptcy or prompt them to self-ration care, and insurance companies will continue to have a choke hold on our health,” says Deborah Burger, RN, a co-president of the 170,000-member National Nurses United union .
NNU, a union that represents frontline healthcare providers—and that has taken then lead when it comes to real reform—offers a savvy respone  to the hyperbole that's coming from in and around the Supreme Court chambers this week:
Despite its name the Affordable Care Act has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar. Nurses now routinely see patients who have postponed needed care, even when it might be life saving, because of the high co-pays and deductibles.
Delayed dental care illustrates the problem. A February Pew Center report noted a 16 percent jump in the number of Americans heading to emergency rooms for routine dental problems, at a cost of 10 times more than preventive care with fewer treatment options than a dentist's office.
Premiums have jumped 50 percent on average the past seven years, according to a Commonwealth Fund report last November, with more than six in 10 Americans now living in states where their premiums consume a fifth or more of median earnings.
Medical bills for years have been the leading cause of personal bankruptcy. Increasingly they ruin people’s credit as well. Another Commonwealth Fund report earlier this month found that 30 million Americans were contacted by collection agencies in 2010 because of medical bills.
Fifty million still have no health coverage. Another 29 million are under insured with massive holes in their health plans, up 80 percent since 2003, according to the journal Health Affairs.
The percentage of adults with no health insurance at 17.3 percent in the third quarter of 2011 was the highest on record, up from 14.4 percent just three years earlier, Gallup reported.
On quality, the U.S. continues to lag far behind other nations. Two breathtaking examples:
More than 80 percent of U.S. counties trail life expectancy rates of nations with the best life expectancies, the University of Washington found last June. Some U.S. counties are more than 50 years behind their international counterparts.
The U.S. ranks just 41st in the world in death rates for child bearing women, and it has been getting worse, according to the World Health Organization. The average mortality rate within 42 days of childbirth has doubled in two decades, partly due cuts in federal spending for maternal and child health programs the past seven years.
Our economic meltdown has exacerbated the crisis. For the past year, nurses have seen a spike in health woes associated with job loss, high medical bills, poor nutrition and other economic factors. These include stress-induced heart ailments in younger patients, hypertension, anxiety and “gut” disorders.
“More handouts to the private insurers and other healthcare corporations will not improve these dreadful statistics,” says Burger. “The choke hold on our health by the same Wall Street types who tanked our economy is exactly what has caused the falling health barometers on access, quality, and cost.”
"The consequences of the denial of care en masse—now and in the future, with or without the ACA—could not be more ominous, explains NNU co-president Jean Ross. "Only more comprehensive reform, Medicare for Life, for all Americans, will finally produce real healthcare security for our country."