How can America improve its health-care system? Is the Affordable Care Act a step toward a remedy? Tonight, Malcolm Gladwell will talk with David Goldhill, the author of the new book “Catastrophic Care,” about these issues and more. Follow this link to watch the live stream of the event now: http://nyr.kr/SxsCiB

In 1973, two social scientists, Horst Rittel and Melvin Webber, defined a class of problems they called “wicked problems.” Wicked problems are messy, ill-defined, more complex than we fully grasp, and open to multiple interpretations based on one’s point of view. They are problems such as poverty, obesity, where to put a new highway—or how to make sure that people have adequate health care.

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Solutions to wicked problems …are only better or worse. Trade-offs are unavoidable. Unanticipated complications and benefits are both common. And opportunities to learn by trial and error are limited. You can’t try a new highway over here and over there; you put it where you put it. But new issues will arise. Adjustments will be required. No solution to a wicked problem is ever permanent or wholly satisfying, which leaves every solution open to easy polemical attack.

Atul Gawande on why universal health-care in the United States is a wicked problem, and why the uninsured are still vulnerable: http://nyr.kr/MDJqA8

While the Supreme Court’s decision to uphold the Affordable Care Act is obviously a great victory for President Obama (and good news for the tens of millions of uninsured Americans), you could also argue that, in the long run, it’s good news for Congressional Republicans. 

James Surowiecki explains how the Supreme Court’s health-care decision may be good for Republicans: http://nyr.kr/MEkaXM

(Source: newyorker.com)

Justice Samuel Alito:
Uphold all or most of A.C.A.? No
Mandate constitutional under Commerce Clause? No
Mandate constitutional under Necessary and Proper Clause? No
Mandate constitutional under Taxing Clause? No
Medicaid expansion constitutional as is? No
Medicaid expansion constitutional with limits? No

The Supreme Court’s ruling on the Affordable Care Act, issued today, proves that sometimes the old cliché really is true: you can’t tell the players—or how they voted—without a scorecard. Click-through for a slideshow breaking down the vote of each Justice, as above for Justice Samuel Alito: http://nyr.kr/MYlC63

From Jeffrey Toobin (currently inside the courtroom), Jill Lepore, Amy Davidson, and more…

On the eve of the Supreme Court’s decision on Obamacare, here’s a message to all the conservative activists out there, for whom this day has been a long time coming: Hats off to you! Unlike many of your opponents, you know how to build and sustain a political movement.

John Cassidy surveys the historical landscape of the health-care industry in anticipation of the Supreme Court’s ruling: http://nyr.kr/MTKXkP

So much for “health-care Monday,” which had Washington and the media world in a rare tizzy.  Shortly after ten o’clock this morning, John Roberts and his colleagues handed down a bunch of rulings, some of them significant, such as one that struck down part of the Arizona immigration law, but none of them pertaining to the Affordable Health Care for America Act, a.k.a. Obamacare.  The justices, like producers of a Hollywood soap opera, were keeping their best plot twist for the end. 

John Cassidy on how the Supreme Court gave hope to both sides on health care: http://nyr.kr/MTu2LH

Jeffrey Toobin provides a guide to what’s really at stake in the Supreme Court’s hearing of the health-care case: http://nyr.kr/JSQGIk

Comment: Heavy Burden

It’s tempting to analyze the case in the context of election-year politics, to game out how Obama might be helped or hurt by the Court’s eventual decision. (Thumbs down on the act discredits the President with moderates—or, maybe, mobilizes his base. Thumbs up, maybe, does the opposite.) But the decision is a great deal more important than its immediate political aftermath. It’s about what the government can do, not just who runs it. If the Court acts in line with the sentiments expressed by the conservatives last week, it could curtail the policymaking options of Congress for a generation. An adverse decision on the Affordable Care Act could even jeopardize the prospects for conservative legislative priorities, like health-insurance vouchers or private retirement accounts in lieu of Social Security. It is simply not the Supreme Court’s business to be making these kinds of judgments. The awesome, and final, powers of the Justices are best exercised sparingly and with restraint. Their normal burdens of interpreting laws are heavy enough. No one expects the Justices to be making health-care policy any more than we expect them to be picking Presidents, which, it may be remembered, is not exactly their strength, either.