In approving the constitutionality of the Affordable Care Act, Chief Justice John Roberts may have wanted to gently rebuke Congress for pushing the Commerce Clause too far, though he let it slide as a tax.

Even so, its important to place this ruling in context.

Today and into the foreseeable future, the political parties are far apart and not likely to compromise.

The same organizations that in 2009 contributed $1.2 billion to Congress in exchange for influence over the laws formulation remain engaged.

While the individual mandate will allow us to spread risk more broadly and make access more available, especially to lower income Americans, it isnt perfect.

The dire problems of extravagant health care use, unit pricing and cost remain largely untouched by the law in its current form.

High cost barely touched

Half or more of all U.S. health care spending provides no value by design, meaning that Americans pay double for health care compared to citizens in other developed nations, and our quality is spottier.

The requirement to keep up with this excess through the mandate will be onerous for many Americans.

As analyst Bob Laszewski points out, a household with a $60,000 annual income will need to find 9.5 percent, or $5,700, for the premium.

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Health care end game hasn't started