While the Supreme Court’s decision last week has spawned a fierce backlash, it did make Affordable Health Care the law of the land – at least for now. This is an enormous step, for it proclaims it a national goal to provide good health care for everyone. As we address the critical question of how to pay for it,  two things are worth remembering: (1) the United States already spends more on health care than any other country; and (2) those currently uncovered either go without care or get emergency treatment at public expense. In either case, the cost to the nation is enormous.

As discussed in a post on Woody Brock’s book, the key is to increase the supply of health-care providers faster than rising demand – something that has not happened under the current system. The source of that new supply already exists, but to take full advantage of it requires a shift in how we think about medical care.

The source is nurse practitioners and the shift is from surgical invasion to preventive and community care. (Full disclosure: my daughter is an NP and I have served on the board of a nurse-managed health center). This is not new. In the 19^th century, surgeons were considered skilled craftsmen; now they command superstar salaries from competing institutions. As someone with titanium knees, I know the value of good surgeons. But the key to universal health care is preventive medicine, good health habits and clinics that understand the needs of their clients. It is the dearth of these things now that is both driving up health costs and damaging the nation’s health.