In case you didn’t know, the Supreme Court upheld key provisions of The Patient Protection and Affordable Care Act (PPACA). This decision will allow for the greatest change in our healthcare system since Medicare and Medicaid were enacted. While in some ways the envy of the world, we spend an exorbitant amount for mediocre results when taken as a whole and when compared to the rest of the world. As an Emergency Physician, I have a front-row view of the really good and the really bad of how we care for our citizens and pay for that care. Whether you agree or disagree with PPACA, we are now confronted with the addition of at least 30 million citizens to our healthcare system, not including those who will be added with the expansion of Medicaid.