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With his surprising vote to uphold the core of the Patient Protection and Affordable Care Act, Chief Justice John Roberts may have salvaged the legitimacy of his court. A lopsided majority of Americans has come to see the court as just another partisan institution, according to a recent poll, and the chief justice probably doesn’t want that as his legacy.

Whatever his reasons, Roberts did his country a great service by paving the way to universal health care. Until Congress passed “Obamacare” in 2010, the United States had remained alone among industrialized Western nations in its failure to institute a health care system that was really, well, a system.

Every other major Western democracy has a system in which all citizens have access to health care, whether provided by the state (Great Britain) or through a combination of public and private insurers (Germany). And all of those countries have better health outcomes — measured in statistics such as life span and infant mortality — than the United States. No matter how many times that a conservative argues that this country offers the best health care system in the world, it’s just not true.

Yes, you’ve heard news accounts of wealthy Arab potentates and deathly ill dictators coming to this country for this or that procedure because they believe the medical care in the United States is top-notch. And, at some hospitals, it certainly is. There’s no doubt that the U.S. offers cutting-edge research, advanced pharmaceuticals and world-class medical innovations. Unfortunately, many Americans cannot afford them.

A medical care system should be judged by the quality it offers to the majority of citizens; on that score, the U.S. is hardly the best. In this country, life expectancy is 78.2 years. In Germany, it’s 79.4; in Great Britain, it’s 80.5; and in Switzerland, it’s 82, according to statistics compiled by the United Nations. And that’s despite the fact that Americans spend so much more on health care. It’s money that is not well-spent.

The Affordable Care Act won’t fully renovate the country’s warped system of health care. It will still be expensive, wasteful and less focused on prevention than it should be. But now, 32 million more Americans will be able to visit a doctor, get a vaccination, get a mammogram or get medication for hypertension. Insurance companies can’t jack up customers’ rates willy-nilly because they get sick, or refuse to sell them a policy because 10 years ago they had cancer. That is, as Vice President Joe Biden once memorably put it, “a big (expletive-deleted) deal.”

For decades, conservatives have argued that health care is best left to a free market, which, in their view, provides the best solutions. But health care is not like any other market. You may decide not to buy a flat-screen TV or a hybrid automobile, but you literally put your life at risk if you decide not to purchase health care.

Nor do health care consumers realistically have the option of shopping around for a better price. It’s absurd to think that the average 55-year-old woman, upon hearing the news that her breast biopsy has showed cancer, would start to dicker over the price of chemotherapy: Well, let me see if it’s cheaper across town.

At some point, each and every one of us will purchase health care. Many young and healthy Americans, however, choose to take their chances and avoid the expense of medical insurance. Still, lots of them end up with injuries or illnesses that take them to the emergency room. And that drives up prices for everybody else.

That’s why the widely reviled “individual mandate” was necessary — to make sure that those “free riders,” as Mitt Romney once called them, buy health insurance. When Romney championed the Massachusetts version of the Affordable Care Act, he insisted that the individual mandate was good policy. Indeed, he defended it as recently as last January, during a GOP debate: “Because the idea of people getting something for free when they could afford to care for themselves is something that we decided in our state was not a good idea.”

Now, virtually all Americans will have access to health care, and the nation will be stronger and healthier for it. That’s a very big deal indeed.

(Cynthia Tucker, winner of the 2007 Pulitzer Prize for commentary, is a visiting professor at the University of Georgia. She can be reached at


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