Last week, the US Supreme Court handed down a major decision in the case of King vs. Burwell that saved an important component of President Obama’s Affordable Care Act (ACA). In essence, conservative litigants had sought to block the US government from providing poor Americans with subsidies to purchase health care insurance. (That’s the simple version: the details of the suit are much weirder.) Writing for a 6-3 majority, Chief Justice John Roberts dismissed the suit with only slightly veiled contempt. So ObamaCare, such as it is, still stands.

Writing in The New Republic, I give my view of where health care reform stands in America. I argue that the ACA has only partially achieved its goals. Its principal goal was to get coverage for uninsured Americans, because the U.S. was facing a crisis: Not only were many Americans uninsured, but also their numbers were growing rapidly. The ACA reversed that trend, but at least 10% of Americans still lack health care insurance.

A secondary goal of the ACA was to do something about the problem that Americans spend more on health care than anyone else in the world, but have only mediocre outcomes to show for it. The good news is that the annual growth in U.S. health care expenditures has dropped from 9.6 percent in 2002 to 3.6 percent in 2013. But the decline in the annual increase in health expenditures seems to have stalled since 2009. That’s not good enough: at a 3.6 percent growth rate, health expenditures will have doubled again by 2035.

There are more hard political fights ahead for American health care reformers. Canadians should count themselves lucky that they have largely solved the problem of providing health insurance to all citizens.

But this has, I fear, created a false complacency among Canadian elites. It’s false because Canada also needs to develop effective strategies to control the growth in national health care expenditures while improving the quality and timeliness of care. Every informed person knows about these problems — it’s time for our politicians to take up the fight for change.

William Gardner
William Gardner is a child psychologist at the Children's Hospital of Eastern Ontario and Professor of Epidemiology at the University of Ottawa. He writes professionally on children's mental health, on statistical methods in social research, on Canadian and US health policy, and on ethics. He also blogs at The Incidental Economist. @Bill_Gardner

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