The U.S. Supreme Court’s upholding of most of President Obama’s health-care law doesn’t end the discussion of health care in this country. Fixing the system has a long way to go.

The court’s 5-4 decision was somewhat of a surprise. Conservatives had argued that Congress could not use the concept of interstate commerce to force everyone to buy health insurance. The court’s majority decision essentially agreed with that.

However, Chief Justice John Roberts and the four liberals on the court said the government’s move amounted to a tax – and that is something well within the power of Congress. People still won’t have to buy health insurance, but they will face a tax liability if they don’t.

As much as the health-care debate has centered on legal arguments, the fact remains that our health system is flawed. The new law will fix some of that, but we still have a long, long way to go.

Most Americans have health coverage provided by large employers. They won’t see major changes. The real impact is for the poor.

There are 32 million people in this country who are shut out from having health care. Either they are too poor to afford it or they are so sick that a private insurance company won’t provide them coverage.

The law will change much of that, by expanding Medicaid – the federal/state program that helps the poor – and by making Health Benefit Exchanges available where people can compare costs and benefits of health insurance programs.

However, these improvements come at a cost – or at least a concern. Making sure all people have health insurance means more people will be seeing physicians. Today, there are not enough doctors to treat all these new, potential patients.

The health-care debate will continue – it is, after all, a presidential election year. But if it’s done nothing else, the Supreme Court’s decision has forced politicians and the public to face this issue. That, at least, is a start.

– Craig Groshart, Bellevue Reporter