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At oral arguments before the Supreme Court yesterday, two of the conservative justices — Samuel Alito and Antonin Scalia — both floated versions of the idea that, if the Court does strike down Obamacare subsidies in three dozen states, it might not be that big a deal, because surely lawmakers would then fix the problem and avert disruptions for millions. ... But here’s the thing: It seems likely that it will only get harder later this year — not easier — for Republicans to fulfill any promise of a backup plan, either on the state or federal level. By then the 2016 GOP presidential primary will be in full swing, and continued Total War resistance to Obamacare — in the form of opposition to any fix that Obama and Democrats will be demanding — could very well emerge as a conservative litmus test. (Greg Sargent, 3/5)

Opinions about the big Obamacare case the Supreme Court heard this week are highly polarized. But the court could find a way to split the difference between the conservative and liberal readings of the law -- and that might be the worst of all worlds. ... It could find that the conservative reading of the law -- that states must create exchanges if they want the subsidies -- is right. But it could also say that the federal government has no right to set that kind of condition on states -- that doing so would violate the constitutional principle of federalism. By that logic, the subsidies could be allowed to continue. (Ramesh Ponnuru, 3/5)

One obvious government program that, at least at this point, is still underutilized is the Affordable Care Act. According to a recent survey from the Kaiser Family Foundation, there are still about 30 million adults in the U.S. who are without health insurance—almost half of whom (48%) would qualify for subsidized insurance from the exchange. (Mike Piper, 3/5)

After a century of fierce political debate in the U.S. over national health insurance, the fate of our new, near-universal coverage system almost certainly will be determined by either [Chief Justice John] Roberts or Justice Anthony Kennedy. If both of them vote to strike down premium subsidies in as many as 37 states using the federal insurance exchange, that could be the beginning of the end for the Affordable Care Act. But they could rule in a way that preserves the subsidies for now while putting healthcare reform at the center of the 2016 elections and letting American voters decide the issue. (Harris Meyer, 3/5)

The much-awaited Supreme Court oral argument in King v. Burwell took place Wednesday. A review of the transcript indicates that the lawyers – Solicitor General Donald Verrilli and Petitioners’ Counsel Michael Carvin – brought their A game. And so did the justices. Here are some quick-analysis thoughts. (James Blumstein, 3/5)

As I noted on Wednesday, Justice Anthony Kennedy expressed little sympathy for the federal government’s textual arguments in King v. Burwell, but he did seem concerned about the federalism implications of reading the ACA statute as urged by the plaintiffs. Although there are already several VC posts discussing the federalism issues in King, I thought it was worth exploring the nature of Justice Kennedy’s apparent constitutional concern, and its potential implications, in a bit more depth. (Jonathan H. Adler, 3/5)

If you're going to lose a limb at work, try to avoid doing it in Alabama. That's the gist of a new investigative report by ProPublica, partnered with National Public Radio, which explores the inequities and blatant unfairness within the workers' compensation system (Alabama has the nation's lowest benefits). (Scott Martelle, 3/5)

Jim Makichuk bought a 5-gram tube of Zovirax, a prescription cold-sore cream, a few years ago in Canada for $34.65. That was the over-the-counter price; no insurance involved. He recently purchased a fresh 5-gram tube from a Kaiser Permanente pharmacy in Los Angeles. It cost him $95, or nearly three times as much as the Canadian price — with insurance. But that's not what raised Makichuk's eyebrows. What surprised him was a report Kaiser sent him on prescriptions he filled in January. There was the tube of Zovirax, and there was the $95 payment Makichuk made. And beside that was a listing for what Kaiser paid for the cream: $2,532.80. (David Lazarus, 3/5)

Canada has a well-founded reputation for dangerous exports: Dirty oil. Strong beer. The occasional bad pop song. ... Still, the U.S. pharmaceutical industry's concern about a law that let Maine residents buy prescription drugs from Canada is a little odd. There's no evidence that medicines from Canadian pharmacies pose any greater safety risk than those bought in the U.S. Yet industry trade groups last week persuaded a judge to overturn the law, on the narrow grounds that drug importations are a federal matter. (3/5)

An online program created in collaboration with the UC San Diego School of Medicine faculty aims to help address the nation’s shortage of primary care physicians, a critical health-care issue highlighted by the Association of American Medical Colleges on Tuesday. (Leonard W. Glass, 3/5)

Health care consumers won a significant victory when Massachusetts Suffolk County Superior Court Judge Janet Sanders blocked a settlement that would have allowed Partners HealthCare, the system that dominates the Boston area, to acquire three additional health care providers in eastern Massachusetts. Sanders concluded that the acquisitions “would cement Partners' already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices from insurers for the services its providers render.” If this decision is not overturned on appeal, consumers will now be spared those projected price increases. But there is an even bigger reason for New Englanders to celebrate the judge's ruling. The danger lay not only in Partners' expanded dominance but also in the degree to which the settlement would have shut out other innovative competitors. (Regina E. Herzlinger, Barak D. Richman and Kevin A. Schulman, 3/4)

I was a harried, green resident busily readying an elderly patient — call her Margaret — for hospital discharge when her face unexpectedly began glowing with pleasure. Looking me intently in the eye, she exclaimed, “I do hope you know Dr. Edgecomb!” But before I could respond, she continued, “Do you know what he told me when I left his office last time? `Now you just be sure to notice the crocuses by the doorway on your way out, Margaret; they're lovely this year.' That's just the kind of person he is . . . and he was so right about the crocuses.” ... As Margaret cheerfully waved goodbye to me, I had to face up to the obvious: she really loved her doctor, and I — the cynical novice — envied him. I hoped my patients might one day think as fondly of me, but I was only beginning to learn how doctors inspired gratitude. Dr. Edgecomb had brought delight to his patient, and I couldn't help wondering: Are doctors supposed to do that? (Dr. Michael W. Kahn, 3/5)

Of all the pressing challenges in the US health care system, lack of innovation in delivery may be the most important. Indeed, as we come upon the 50th anniversary of Medicare, a few facts seem apparent. What we do for patients—whether they have infectious diseases, heart disease, or cancer—has changed dramatically. Yet, how we do those things—the basic structure of our health care delivery system—has changed very little. This lack of innovation in how we do things is a major reason why health care productivity has been so low and high spending has had insufficient benefits for patients. (Ashish K. Jha, 3/4)