By George Pauk, M.D.

The Affordable Care Act, whose fate currently rests in the hands of the Supreme Court, has been characterized by some politicians as a major health reform. In fact, the law represents only a small increment of change. From a system standpoint, it hardly rocks the boat. It keeps for-profit health care corporations in the driver’s seat.

The ACA was carefully crafted to avoid upsetting the “gorilla in the room” – the private insurance industry – and was largely tailored to benefit that industry, particularly by facilitating the expansion of its customer base by at least 16 million people and lavishing it with over $447 billion of taxpayer money.

The last major health reform worthy of the name was the 1965 enactment of Medicare, a publicly funded program that has sharply reduced poverty, relieved suffering and saved countless lives. The ACA’s impact, if it is upheld by the court, will be much more modest by comparison. The main reason why: it leaves our population firmly in the grip of the avaricious private insurers with a class and employment based and fragmented system.

The arguments over the ACA at the Supreme Court last March were illuminating. Did you hear the justices, lawyers, and politicians on both sides of the law opining with authority about our health care? Wow, they seem to really think they know their pathology, epidemiology, pharmacology and health care “system-ology.”

I remember wondering at the time if I should ask Chief Justice Roberts for advice about my gall bladder or just how much broccoli I should eat.

Unfortunately, Congress and the White House have succumbed to the blandishments of the medical-industrial complex. They’ve become captives to corporate lobbyists and big campaign donors. As a result, they’ve spurned the voices of those most qualified to speak about health care: our nation’s patients and the health professionals who care for them.

Most on-the-ground health care providers (including physicians, nurses, social workers and therapists) believe that private insurance companies represent unnecessary, profit-seeking middlemen who should be replaced by a single-payer, publicly financed program providing truly universal, comprehensive care: i.e. an improved Medicare for All.

A peer-reviewed survey in the Annals of Internal Medicine in 2008 showed 59 percent of U.S. physicians now support government legislation to establish national health insurance, a jump of 10 percentage points from just five years before.

Polls, surveys and “citizen juries” have consistently shown that two-thirds of the public agrees with the idea of improving the Medicare program and expanding it to cover every person in the United States from birth to death. Just drop two words, “over sixty-five”.

The main obstacle to achieving this commonsense goal (and the main factor causing the deterioration of health in the United States today) has been the corporate takeover of health care and the for-profit health industry’s political lobbying.

Corporate lawyers, politicians, and business people have run us through a dizzying spin of HMOs, PPOs and the latest fad, ACOs, and through other so-called reforms with the goal of establishing privatized, corporate profit centers.

Today, it is more or less accepted as a given that health care CEOs “earn” yearly rewards in the tens of million dollars for making profits off the sickness of our patients. Unfortunately, the remaining nonprofits have adopted many for-profit practices.

Yet it is clear that the private insurers’ brutal denial and delays in authorizing care result in enormous human suffering and the premature death of many thousands each year.

The insurance industry is not like a physician or nurse, whose goal is to provide good care for a patient. The insurers know they will be rewarded by allowing less care, or by denying care. Such denials boost the insurers’ bottom line. Ethics goes out the window in this callous calculation. Cost control of health care is also not in the interest of business simply because larger volumes of funds provides larger profits.

We now await the Supreme Court ruling. The court, which has generally favored corporate interests, may rule to uphold the law or to strike it down, in whole or in part. In either case, we’ll still end up saddled with the greedy private insurers.

We can’t go on like this. It’s immoral and economically unsustainable. Whatever the court’s ruling is, our nation needs to immediately move to enact true reform: a single-payer system, otherwise known as an improved Medicare for all.

Dr. George Pauk lives in Phoenix, where he practiced internal medicine and endocrinology until his recent retirement. He is a member of Physicians for a National Health Program (