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Roberts called Obama a liar.

Obama repeatedly insisted the mandate was not a tax. Roberts says, oh yes it is.

Congress can impose taxes. Congress can also repeal them. We elect congress.

Roberts also essentially said Congress and the President are free to pass stupid laws. Money quote from his opinion:

“We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”

“Obama repeatedly insisted the mandate was not a tax. Roberts says, oh yes it is.”

Although I am disappointed with the decision, it doesn't surprise me, and your assessment is very thoughtful. I'm not sure this is so bad, and I'm a doc. I have been despondent about my profession ever since the passage of Obamacare, so it would be very hard for me to be even more depressed about what has happened to American medicine. It appears to me, at first glance, that this decision makes Obamacare more vulnerable to legislative action.

That said, I think Roberts did what he did because of exactly what you stated. He distilled this down to a matter of whether or not, as a tax, Obamacare could stand. By doing so he implicitly stated that the commerce clause doesn't apply. He, unlike the leftists on the court, has tried to restrict his role to one of strict constitutionality, and not ideology. We all wanted him, and the other members appointed by Republican presidents, to make an ideological decision based on conservatism. Although ironic to us, he likely views himself as restricted from doing that by the constitutional restraints placed on his role.

U.S. medicine has been in trouble for a long time, not because it isn't the best in the world, but because it became a political focal point long ago. When DRG’s came on board in the 80s it was already a game changer. I strongly believe that a much better model, that can revitalize the profession, can be fashioned. Don't know if it will happen soon enough to make a difference in my professional lifetime, but I do know that if it doesn't happen many patients will suffer. As it stands, although I love seeing patients and strongly consider it a tremendous privilege to be able to care for people's health, I have very little enthusiasm for my profession as a whole.