The Supreme Court has ruled the Affordable Care Act is the law of the land, and of course everybody knows if that’s good or bad.

I wish I had that kind of certainty about how to rearrange one-sixth of the economy, but health care – that’s a tough one. Here’s what I think:

I think talk about the health care system being "the greatest in the world" is grossly misinformed. In some ways it is the best, but it’s breaking the country financially. So I think I’m glad that someone at least brought up the subject.

I think the health care system should have been reformed through a multi-year process where elected officials, insurance providers, the health care profession and consumers (because we’re not stupid) soberly weighed the facts, balanced competing priorities and made hard choices. The Affordable Care Act would have been so much better had it included more conservative ideas, such as medical malpractice reform. That would have happened if elected officials in both parties still believed in the value of cooperation.

I think, unfortunately, that the political system is incapable of that, not when the next election is never more than two years away and the campaigning never ends. And not when the money never stops flowing into Washington and the media’s talking heads never shut up.

I think that means if anything was going to be done about health care, it unfortunately had to be done in a hurry. I think that means the political system needs reform as badly as the health care system does – term limits, four-year terms for members of the House, something. I don’t think that’s going to happen.

I think my real problem with the Affordable Care Act isn’t that it’s some kind of radical change but that it’s much more of the same: More big government and more big insurance. The biggest problem with the way we finance health care is that it’s not a free market in any way. Consumers don’t act like consumers and sellers don’t act like sellers because the recipient rarely pays for the service when he or she receives it. A third party pays most of it later.

I think consumers need to feel the cost of something so that they’ll consume less of it and shop around for better prices when they do. I think insurance needs to be seen as a hedge against big loss and that we need to be personally responsible for our minor ailments.

What if a hefty "food premium" were held out of paychecks at the beginning of the month? What if there were no price tags at the supermarket, and consumers bought whatever the clerks told them to buy and then made a small food co-payment, and maybe a bill came later in the mail and maybe it didn’t? And what if sometimes the supermarket was paid for its services, and sometimes it wasn’t?

I think we’d be talking about a crisis in food delivery.

I think, however, that health care is not like other commodities. If we want steak but only can afford hamburger, we buy hamburger, even if the neighbor is buying steak. When it’s us or our loved one in intensive care, we demand the steak.

I think mandating Americans to buy a private product is a dangerous step. What else are we going to be required to buy? But I also understand why it originally was a conservative idea. Under the current system, many consumers never pay into the system and then get "free" care when they need it.

I think that hospitals can’t run a business that way. I also think it’s not fair to the rest of us.

I think that no health care policies, liberal or conservative, can solve the root problem: Americans increasingly are becoming an unhealthy people, and that includes the American I see in the mirror. We consume too much fat, sugar and alcohol; we don’t exercise; we ingest, inhale and inject ourselves with goodness knows what – and then we expect the health care system to deal with the consequences cheaply or even freely.

I think that, more than high taxes and regulations, what’s really killing jobs right now is the lack of clarity coming from Washington. Employers don’t know what’s going to happen – with health care policy, with taxes, with anything – and so they play it safe and don’t hire or invest.

I think that is not going to change any time soon, even with this Supreme Court decision.

Steve Brawner is a Bryant journalist whose blog, Independent Arkansas, is linked at E-mail him at