I’m tense thinking about the forthcoming decision from Supreme Court on Thursday about the Affordable Care Act. Like many people, especially those in public health, I was elated when health reform finally made it through Congress after years of false starts and bad finishes. It isn’t perfect, but it has potential to do the job. Now, the act hangs in the balance, and we wait for the Court to tell us what’s next. In all the politics and polemics, we should not forget that if the justices decide the mandate is unconstitutional, then one of the core principles of the legislation will have been overturned. That would threaten the economic foundation on which the legislation was built, because the mandate works against adverse risk selection. I know one thing – while I am proud of this country, people still die because they lack access to health care, let alone good health care. I’m not proud of that, and no one should be. Let’s hope the justices do the right thing for all of us. It’s a matter of life and death.