Thursday the Supreme Court issued its historic decision on the Accountable Care Act (Obamacare). I was speaking to the Indiana Hospital Association where they broadcast it live. When the reporters first announced that the individual mandate was unconstitutional there was an audible gasp, it meant that for hospitals it was going to be business as usual. For “safety net” hospitals (those who see the most uninsured emergencies) it meant no relief, but then they corrected themselves and said that indeed it was constitutional and you could hear the sigh of relief.

The reaction to the decision was predictably divisive, with politicians vowing to repeal it, but whatever happens from this time on, how healthcare is delivered in this country is going to change… and it’s about time. Whatever your political persuasion, everyone knows that we can’t afford to spend 20% of our GNP on healthcare, that’s eighteen times higher than any other country and we are not the healthiest country in the world (not even in the top 20). We’re good as we are in acute care and trauma but 85% of all healthcare costs are for the treatment of chronic diseases (hypertension, diabetes, mental illnesses, obesity), and for people in the last 18 months of their lives. We can provide better, cheaper healthcare by moving from the current interventional model to one that’s based on prediction and prevention.

With my friend and colleague Scott Wordelman, Pres/CEO of Fairview Redwing Hospital in Minnesota we outlined a model that moves hospitals beyond their walls and into the community to integrate existing resources. We talked about the difference between healing and curing, and how to make heartfelt connections with people in ways that inspire them to become the principal agents in their own healing.

The Affordable Care Act signals a dramatic cultural change in healthcare delivery and I’m feeling good about it; so good that I took a couple days off to celebrate after speaking in Maine last week. I stayed in a cottage built over the water. It came with a hot tub on the outside deck that looked over Penobscot Bay where I watched the sunrise and set. I read, dozed, picnicked on a mountaintop overlooking a quaint harbor with tall sailing ships. and ate lobster at dusk as I was enveloped in a misty fog.

I have a dream, it’s a healthier nation, and I see it happening.