Celebrate briefly . . .

Good. Now sober up. If we are to make progress toward solving the critical failings in our health care non-system, we need to deal with the problem of universal access, and we need to tame the perverse market forces that suck up money while hurting patients.

The Affordable Care Act doesn't actually accomplish either of those goals -- especially with states free to refuse to participate in the Medicaid expansion, which I suspect Texas and Mississippi will do, at least for as long as they can hold out. But the Act does create a regulatory framework which makes it possible to make progress toward those goals.

If the court had overturned it -- as four of the justices wanted to do, in its entirety -- we would have faced utter chaos, economically, systemically, and politically. The price of insurance would have soared, fewer and fewer people would have been able to afford it, tertiary care hospitals and emerging integrated care networks would have faced ruin. At least now we can try to take some steps forward.

But this is not the end, or even very much progress. It just makes it possible to fight on.