In this file photo taken May 14, 2012, Kathy Watson sits outside Shands Lake Shore Hospital, where she receives her cancer treatment and also picks up patients for her medical transport company, in Lake City, Fla. Watson voted Republican in 2008 and believes the government has no right telling Americans to get health insurance. Nonetheless, she says she'd be dead if it weren't for President Barack Obama's health care law.

Associated Press

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The Affordable Care Act remains in Republican crosshairs and very much in the news. In recent days, several patients have asked me what the law will mean for them. Many of the people I care for are incurably ill and need expensive medical care to stay alive. They've heard politicians say "Obamacare" will take away their choices, rob them of hope for living longer and cast their fate to "death panels" of faceless bureaucrats. Fortunately, none of this is true.

As a palliative care physician, I was relieved by the Supreme Court's ruling and hope Congress allows the law to stand. This is not a partisan reaction. Diseases know no politics. I'm relieved because this law may well unravel patterns of payment and practice that promote irrational care and make dying much harder than it has to be.

Today, most doctors are salaried employees and health care is a complex industry. Yet we still pay physicians for the quantity of procedures they perform rather than the quality of care and results they provide. Our system is specialist-centered rather than patient-centered. And anyone who has watched a loved one die badly will tell you that sometimes specialists do too much.

Our current structure for financing and delivering medical treatment developed in the decades after World War II, when doctors' offices were the engines of the health care system. Doctors were paid for services: an office visit, house call, setting a broken bone, performing an appendectomy or tonsillectomy. The busier doctors were, because of demand or reputation, the more money they made.

The state of end-of-life care in America is marked by too many treatments and too little attention to alleviating pain, clear communication between doctors and patients (or their families) and coordination among multiple specialists or treatment centers. In the quest to save lives, our health care system has become exclusively a disease-treatment system.

Medical miracles abound: antibiotics, sophisticated surgery, organ transplantation, artificial kidneys, mechanical ventilators, implantable defibrillators and pumps to assist failing hearts. But medical science has yet to make one person immortal although from the way the health care is paid for and delivered, you would think we had.

In the prevailing fee-for-service financing system, insurers, including Medicare and Medicaid, routinely reimburse hospitals and doctors for treatments regardless of whether they have been proved to be effective. All of this makes money for doctors, hospitals and pharmaceutical and medical device companies. But it makes no sense for dying people, only adding to their and their families' miseries.

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Health care reform law will lead to rational care, not rationing