With an estimated 43 million Americans lacking health insurance and a medical care system that eats up ever-larger percentage of the gross domestic product, health care remains an intractable issue.

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The challengers conceded that the government could do many things to regulate the health-care market, including requiring individuals to pay for medical services with insurance or creating a system in which the government pays for everyone's care.

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The Trust would be the primary provider of prevention priorities for all Americans, irrespective of insurance status, and would connect back to the medical system through an electronic health record.

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And yet the private insurance reimbursement model is literally built on a system of foisting huge overhead on small medical practices.

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In place of creating a national health system, the law bans insurance companies from denying coverage to people with pre-existing medical conditions, bars insurers from setting a dollar limit on health coverage payouts and requires them to cover preventive care at no additional cost to consumers.

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