Let's be clear.  June 2012 may be one of the most consequential months in U.S. health care policy history ever. This is the month the U.S. Supreme Court (SCOTUS) is expected to hand down its ruling on the Affordable Care Act (ACA/ObamaCare). Some expect the ruling in the first ten days of June, and some expect it in the final ten days, and nobody seems to expect it in the middle ten days.

By my count, there are eight possible Supreme Court outcomes, ordered from less to most impactful -- SCOTUS could:

It's a truism in public health that when their job is done well, no one notices. No one notices water that isn't dirty, air that's clean, poisonings that don't occur, diseases and infections that don't emerge.

Well, not always.

I just finished reading the recently published autobiography of Dr. Joseph B. Martin MD, former Dean of Harvard Medical School (1997-2007) and Dean of Medicine and Chancellor of the University of California, San Francisco, Medical School. He has written a compelling personal history of U.S. academic medicine since the 1970s that honestly confronts many of the controversies and conflicts afflicting our medical system, especially the conflicts of interest between American medicine and the industrial medical complex.

Dr. Martin was born into a Mennonite farm family in depression era Alberta Canada in 1938. One of his many compelling stories involves his uncle Sam who went to prison rather than violate his religious objections to military service in World War II. In spite of a lifetime career in the cathedrals of American medicine, he never lost that common sense approach to difficult decisions.

Catching up on some late reading, and something from the April 21 National Journal jumped out like a rocket and demands attention:

"The Other Jobs Bill: Mitt Romney lionizes entrepreneurship. His health care law -- and possibly the national version based on it -- helped more than he knew."

Margot Sanger-Katz starts her article by describing Laura Fitton who launched a social media marketing company in 2009. Laura didn't have a lot of money to pay employees, though she found herself able to lure out-of-state talent because of ... Massachusetts health reform. "I absolutely was able to get better people," says Fitton.

Here are extended excerpts from the article which deserves a lot more attention and discussion:

Message to the smart people in the Massachusetts House of Representatives who are getting ready to debate legislation to reform the health care financing/payment system: if you want to save real money and add real value to our society, emphasize prevention and public health, and prioritize it.

Here's the latest, just in time for the House debate, from the U.S. Centers for Disease Control and Prevention:

Reduce the rate of growth of obesity by one percent a year over the next two decades, and slice the nation's health care costs by $85 billion.

Keep obesity rates at current rates -- well below the 33 percent projected increase, and save the nation $550 billion during the same period.

Yesterday's Washington Post op-ed column by Norman Ornstein of the American Enterprise Institute and Thomas Mann of the Brookings Institute deserves wide discussion. Ornstein and Mann are widely respected political centrists, not aligned (unlike yours truly!) with either end of the political spectrum. That makes their insights all the more powerful:

I observe a tendency in both human nature and public policy to see progress in a difficult situation and to declare victory prematurely. Often it turns out that the early victory signs were ephemeral and an opportunity to secure more enduring change gets missed.

Two related examples of that are happening right now, both involve national and Massachusetts health policy choices. One involves rising health care costs, and the other the obesity epidemic and sugar sweetened beverages.

Let's first look at costs.

I confess, it feels strange.

And in Massachusetts, it feels doubly strange.

Just a month ago, the Supreme Court of the United States (SCOTUS) heard oral arguments on the constitutionality of the Affordable Care Act (ACA/ObamaCare). Defenders of the law greeted the arguments with confidence, and then left the Chamber despondent that the incompetent representation of our position was an omen for a disastrous decision to be. Could the conservative SCOTUS majority that selected George W. Bush as president and concocted the Citizens United decision be readying a triple-header?

Hate to say it, beats me.

Prior to Mitt Romney's 2012 presidential campaign, hardly anyone referred to Massachusetts health reform as "RomneyCare." As with "ObamaCare," it was a term of choice only for critics, most of them out-of-state. The libertarian Cato Institute began using it back in 2006. I recall former Boston Medical Center Chief Elaine Ullian using it early and often because she opposed the law's funding reductions for safety net hospitals. Not many more.

Those of us who worked on the law's passage and implementation never used the term for a simple reason. The law Romney proposed in 2005 differed markedly from the law approved by the Democratic-dominated Legislature in 2006. Romney wanted everyone to have access to flimsy, high-deductible coverage; the Legislature insisted on fuller coverage for those getting access to the subsidized Commonwealth Care coverage, and a choice of skinny or full for everyone else.

Romney was governor for less than nine months into the law's implementation. Most key decisions did not happen until 2007 after his departure and the arrival of Governor Deval Patrick who supported a more expansive version than did his predecessor. We were pleased Romney continued to support the law and promote it as a national model during his 2008 presidential run, though it was no big deal.

And still...

It's time for me to say something nice about physicians, and the organized kind in particular.

For many years, I've noticed that organized groups/stakeholders/associations have an almost impossible taking public positions that violate their economic self-interest. It happens so rarely, at least in the health space, I can count on one hand the number of notable exceptions I have encountered, for example:

• Dentists who support water fluoridation;

• Pediatricians who support vaccination;

• The Massachusetts Medical Society in the 1990s who led a first-in-the-nation effort to make physician liability records available online.

Perhaps you can think of others. They are few and far between. Individuals, even as members of groups, can part company with the herd. It's just devilishly hard for organizations themselves to do so because self-interest is so engrained in their DNA.

This makes it all the more noteworthy that last week nine U.S. physician specialty societies representing 374,000 physicians released a total of 45 recommendations (5 each) for common medical treatments that should not be done commonly by their members on/to patients. For more information on the campaign, check out the website Choosingwisely.org organized by the American Board of Internal Medicine.