My client hesitated at the door before leaving. “So, this ‘feeling stuff’ is supposed to make me feel better?” she asked.

I put a hand on her shoulder and sighed. “Yes. It will.”

I couldn’t bear to tell her that meeting her inner monsters would be like riding a rank bull and getting thrown a few times — or maybe hanging on only to have your face smack the bull’s head — a term professional bull riders call “kissing the bull.”

I wanted to tell her it would hurt like hell, but it would be worth it. Down the road, her heart would expand, and she would feel more keenly connected to the whole human race. She would forgive more quickly, love more deeply, and experience radiant joy. (Disclaimer: I don’t know if any of this is true for bull riders.)

Counseling is an art with diverging theories and a myriad of techniques. (If people only knew!) The good news is it works — at least, most of the time. The bad news is no one gets through life without experiencing the bull a time or two — which often leads people to counseling.

Part of the challenge of learning how to be an effective counselor is that a lot of what goes on in counseling cannot be measured. And the aspects that can be measured occasionally have nothing to do with what makes counseling effective… but the numbers please the funders and universities.

A universal understanding in the field is that after developing a trusting bond, we ask clients to acknowledge and feel their feelings, which ultimately helps them process the feelings. By feeling and processing, the emotions shift and release their hold on us.

When people are accustomed to thinking their way through life, however, they are, at least initially, in for a rough ride. Often clients assume counseling is where they go to spread their life out like puzzle pieces on a table, and us counselor-types hold our chins and analyze it. It’s not so easy when we ask them to be vulnerable. When I ask my clients to stay with their hearts, I have to do it too.

Unfortunately, when it comes to feelings, we are a constipated culture. We’ll do almost anything to talk ourselves out of them. Here’s what I’ve learned about feelings: If you ignore them, they will show up at midnight unannounced and stomp and horn you like a rodeo bull. Bull riders call it getting “freight trained,” leaving you “a bad wreck.” As a result, you’ll send texts you’ll regret, eat most of a bag of Barbara’s Cheese Puffs while watching really old Seinfeld reruns, then stay be up half the night crying because people you love will die some day. Not that I’m speaking from experience or anything.

There are a number of techniques that help remind people to “check in” with their feelings. Laurel Mellin, creator of Emotional Brain Training (EBT), suggests we check in several times a day. Her method offers exercises in response to stress and overwhelming feelings. She says: “Stress is both a worldwide epidemic and a highly personal one. Most people are overloaded these days – depressed, anxious and on edge, with the stress buzzer jammed on. The resulting chronic leakage of stress hormones – that drip, drip, drip – causes extremes of emotions, thoughts, and behaviors. It can impact every organ system in potentially deleterious ways and is the root cause of 80 percent of health problems and most human suffering.”

There is a free App called “EBT” that is directly related to Mellin’s work and a quick way to access the exercises from her book Wired for Joy: A Revolutionary Method for Creating Happiness Within. Another wonderful free App is called “GPS for the Soul.” Created by the founders of HeartMath, GPS for the Soul allows you to use your smart phone to determine how stressed you are. (An excellent way to gauge whether today is the right day to make that big decision.)

When I remember to check in and I use my tools (cellular technology or counseling training), I am able to ride the bull fearlessly, aware that this too shall pass. Let’s just say that life doesn’t go as smoothly when I forget to check in.

A great way to remember to check in is through some sort of spiritual practice. I encourage mindfulness and meditation in order to develop an observer self that can help one identify personal truth as well as take responsibility for his or her perceptions. Personally, I find it helpful to visualize turning over what I cannot handle to a Higher Power, receiving a red rose in return.

Sometimes, when grieving a loss or feeling deep sadness, I have experienced a bottomless pit – the sensation that I may never stop crying. But sadness is a natural and healthy feeling state that will pass in time. On the other hand, depression, which may include lots of sadness and tears, is really a separate state that stifles your ability to feel. It often manifests as hopelessness, numbness, and feeling stuck. After Gloria Steinem’s husband died of lymphoma, she told CBS Sunday Morning “I realized that in depression, nothing matters. And in sadness, everything matters!”

Some people are masters at shutting out memories and feelings and stuff emotions like sadness deep in the recesses of consciousness to prevent them from ever coming to the surface. This is often the case with people who have experienced serious trauma. When the thought of returning to our feelings is too threatening or overwhelming, there are somatic forms of therapy that do not require talking. These techniques include Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, dance therapy, and many methods inspired by the work of Dr. Peter Levine, the founder of Somatic Experiencing Trauma Institute.

Even when trauma is absent, anger is difficult for a lot of people to feel and process. Sadly, according to Dr. John E. Sarno, author of The MindBody Prescription, repression of emotions, particularly anger, is often the source of physical ailments or chronic pain including back pain, fibromyalgia, tendonitis, and abdominal issues (to name a few). Sometimes, the medicines prescribed to counteract these disorders contribute to keeping feelings out of sight/out of mind. Other treatments, including surgery, stretching, chiropractic adjustments, and other alternatives may act only as a temporary placebo. You may feel better for a while, but they do not address the root of the problem: unincorporated emotions, like anger.

When I speak of processing anger, I don’t mean exploding like a detonated bomb. Sometimes, simply acknowledging that you are angry opens the door for that feeling to pass through you. Healthy feelings flow like a river and do not get stuck. There is no justification for punching someone, kicking your dog, or yelling at your children. People don’t “make” us angry or sad. Those feelings are born from a complex process of experiences, associations, and how we make sense of our world. We are the ones who make choices about how we perceive people and how we want to respond.

Once we have some tools, we can stay on the bull, which is a heck of a lot better than being surprised and trampled, because eventually the bull gets tired and stops to eat grass, and then we can slip off unnoticed.

Pema Chodron once she said that when people are happy they expect the feeling to go on forever and ever, and they become disappointed when it ends, but when they are sad or angry they immediately want to escape from the feeling.

Learning to sit with sadness, aware that it too shall pass, deepens our capacity to remain present, and by remaining present, we feel more alive. Happiness is not experiencing joy to the exclusion of other emotions. Happiness is learning to feel comfortable with the spectrum of feelings, and be at peace with the idea that change is the only certainty.

The client who asked if this “feeling stuff” was supposed to make her feel better eventually reported that she was more aware of feelings throughout the day, which enabled her to make better choices when challenged. Ironically it is being willing to experience our own vulnerability that connects us more deeply to loved ones and permits us to stand on solid ground. For all the bumps and bruises, riding the bull helps us appreciate the stillness.

As I think back to all the clients I’ve worked with as a writing coach and counselor, these 10 steps spring to mind as safe and effective practices when dealing with difficult feelings:

1. Seek help from a mental health professional when (preferably before) you get stuck.

2. Accept your feelings without judgment or analysis – invite them into your life. This step gets easier with practice.

3. Turn what you can’t handle over to a Higher Power (God, Allah, Jehovah, Shiva, Buddha, the Universe, the Divine … whatever works for you).

4. Journaling is a great way to get in touch with your feelings. For more information, check out books by Lucia Capacchione, author of The Creative Journal: The Art of Finding Yourself or Kathleen Adams, director of the Center for Journal Therapy and Therapeutic Writing.

5. Get your body moving. Practice a form of movement: dance, yoga, running, cycling, sports, weight lifting, and so on. You’ll benefit from reduced cortisol and increased serotonin levels, which will help you stay out of depression.

6. Feel your feelings, and know that it’s important not to take them out on others.

7. Communicate what you are going through to the people around you and ask for space you need.

8. Accept that anything new is probably going to feel uncomfortable — especially learning a new way of being that is more open and authentic.

9. Develop a daily meditation practice. Twice a day for 20 minutes is all it takes.

10. Accept that feelings are fluid — there’s an intrinsic ebb and flow. Ideally, emotions move through us and help us stay in touch with our hearts and feel more connected to others.

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When we think about love, our soul mate, settling down and getting married, and so on, we often go back to our childhood thoughts on this subject. These thoughts condition how we think, and what we expect our relationships to look like.

Many women think they should be in a relationship, not because they really want one or are ready for one, but because it’s just the right thing to do. The pressure to be in a relationship is so automatic at times that we don’t even think about it. Do you ever notice that when you are single, friends and family are always asking you, “Are you seeing anyone?” or “How’s your love life?” If you say you’re not seeing anyone, they all want to fix you up. Your friends all think that you are such a catch, so how can you be single? On the other hand, if you are in a lousy relationship, they want to know, “Why are you with that loser?” The quest to find Mr. or Ms. Right has become so popular—just look at how many online dating sites, matchmaking services, books and talk radio shows there are on the subject. Everywhere you look, there is some reference to finding the love of your life.

Unfortunately, when you jump from guy to guy without analyzing why you want to be in a relationship, what your needs are, and where your self esteem falls in the range between lower than an ant or as high as the sky, you will tend to fall right back with the same ole’ same ole’… Different guy, in the same pair of pants!

I suggest that you take stock and decide why you want a relationship right now. Do any of these reasons ring true?

•      I am lonely.
•      All of my friends are in a relationship.
•      I can’t afford to go to nice restaurants unless a man invites me.
•      I feel like a loser without a man in my life.
•      My mother keeps asking me when I’m going to get married.
•      My biological clock is ticking.
•      I want to get over my divorce or last relationship.
•      I want a man to support me so that I don’t have to work anymore.
•      I want to get even with someone or make someone jealous.

Many times people just jump right into a relationship or stay in one with the wrong person because they feel that it’s better than being alone. Jenny, a twice-divorced mother of two, has a good job and wonderfully supportive girlfriends, but she repeatedly gets into relationships that are not good for her. She is currently in a relationship with a man who beats her and puts her down because “it’s better than being alone.”

Watching the news lately, I see story after story about someone (usually a woman) who is missing or found dead, killed by an ex-lover or spouse. Even if we are lonely, the people we choose to let into our lives need to be chosen carefully.

That’s why I am inviting you to really look at whether or not you are ready for a relationship right now. Maybe you just got out of a bad relationship, or you’re recently divorced, or had a death in the family and need to heal. There is nothing wrong with being alone and working on yourself to make sure that you are a complete, whole, and healthy person who is ready to give your all with the right person. I’ve always liked the saying, “I’d rather be healthy and alone than sick with someone else.”

If you agree with any of these statements, you want to be in a relationship for the right reasons. For example:

•      I love my life, and I want to share my happiness with someone.
•      I feel totally ready to find my soul mate and start a family.
•      I have so much to give to the right person.

I want you to know that you are a perfect creation on this planet and have a right to be here. You have a right to love, abundance, happiness, success, peace and more. You are worthy of living happily ever after with your soul mate just like in the fairy tales, and that will happen when you are happy right where you are. When you enjoy your own company and feel that you are the catch that all of your friends keep telling you that you are, well, you will be so darn charismatic that nothing can stop your soul mate from connecting with you. And when you come from that powerful place of loving yourself and loving your life, you get to ask yourself, am I attracting the person I really want, or is it the same guy in a different pair of pants?

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In January of 2006, my doctor called me on my cell phone and told me that I had prostate cancer. The concrete literally felt like it was coming out from beneath my feet.

When I met with him in his office a week later, he told me that after the surgery to remove my prostate, he was 90 percent sure that I wouldn’t need to wear diapers the rest of my life and 70-80 percent sure I could still have an erection if I took Viagra. Not a happy outlook at 46.

He clearly thought he was spreading the good news, but his matter-of-fact manner only amplified my feelings of being blindsided.

After a couple of days of feeling suicidal, I broke down and sobbed, and that was the beginning of the turn around.

From there, I went on a mission to discover everything I could about prostates, what makes them healthy, what makes them sick, and how to beat this “thing” that was living inside me.

Someone at Whole Foods handed a friend a book by Dr. Aaron Katz of Columbia Medical School that included preventative and non-invasive treatments for prostate cancer. Three weeks later, I met with Dr. Katz and Dr. Geovanni Espinosa in New York. With their help, the cancer went away: undetectable by biopsy, medical imaging, with a PSA that dropped from 5.1 to under 2.0, and remains that way today.

How did I do it? I changed everything: diet, exercise, started a four-day-a-week yoga practice, began meditating daily, spent more on supplements every month than most professional bodybuilders, integrated Chinese medicine into my daily life, did multiple fasts, juiced daily, read everything I could get my hands on, embraced EMDR therapy, forgave my family, even held a hands-on healing session where 30 of my friends and family laid their hands on me and sent their love.

My mission to create a healthy prostate took me on a healing journey that went far beyond my prostate—beyond cancer even—and into the land of wellness. Sharing the love, the understanding, and the information I’ve gleaned along this journey has become my life’s passion.

During the summer of 2010, I had a string of five epiphanies:

1. The “Standard American Lifestyle” is killing us.
2. If you want to change your life, you have to change your lifestyle.
3. No one wants to be lectured to about the virtues of eating broccoli and daily exercise.
4. The only way to entice people into embracing a healthier lifestyle is to make it fun.
5. Live music makes everything fun.

That’s when the spoonful of music helps the medicine go down philosophy dawned on me. Bringing people together around the music they love is the best platform to inspire/educate them into adopting a healthier, happier lifestyle.

This was the genesis of the BOOM (Boulder’s Outrageous Outdoor Music) Festival. The goal was to weave together the vitality of yoga/music festivals like Wanderlust and Tadasana with the information of TED talks and the joy of listening to your favorite music at music festivals such as Outside Lands or Sasquatch.

In this environment, not only would people have the times of their lives, but they’d be much more open to absorbing new information and embracing change in a way that stuck.  That’s the goal, the mission, the dream.

From moments of inspiration to our current state of planning, the BOOM Festival has been a labor of love—and a search for sponsorship.

If you’d like to help the BOOM Festival get off the ground and reach our August 2013 date, please take a minute to visit our Indiegogo site.

Thank you.

Be well,

Mark B. Saunders

…

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To say there is a lot riding on the Supreme Court’s upcoming health care decision (due sometime in the next week or so), would be overstating the obvious. It’s being hailed as “The Decision of the Century,” although one could argue that Bush v. Gore might have kept us out of Iraq, and therefore saved the country about $1 trillion.

If the Supreme Court’s decision strikes down the Affordable Care Act or its federal mandate, it will impact the parts of the ACA that are already in place: Coverage for young adults on their parent’s health insurance until they are 26, better Medicaid prescription benefits, preventative care without copayments for seniors and working-class families, and no pre-existing conditions for children. All of which are popular programs—even amongst people who are opposed to “Obamacare.”

“If not the ACA, then ‘What will happen next?’ is the question we need to be asking,” said Bill Wehrle, Vice President of Health Insurance Exchanges for Kaiser Permanente. “Right now, that part of it is lacking. If it’s not going to be this federally mandated system, then what will it be? Will we go back to the old system? Single payer? If you can’t have a mandate, what can you have?”

Early answers to those questions came on Monday, June 11 when UnitedHealthCare, one of the nation’s largest health insurance providers, promised to continue allowing young adults under 26 to remain on their patents’ plans, ending lifetime caps on benefits, providing preventative services (like cancer and diabetes screenings) without a copay, and not cancelling policies retroactively—regardless of what the Supreme Court decides.

UnitedHealthCare is the first major health insurance company to officially embrace the most popular provisions of the ACA that have already been enacted. The real test of the health care industry—especially if the law or the mandate is struck down—is how far insurers are willing to go in order to help cover America’s approximately 50 million uninsured.

However, if the court upholds the act and its mandate, expect a Tsunami of bureaucratic activity by the health insurance industry, state and federal governments, and health care professionals—not to mention a full-court political press by Republicans to repeal the law.

If the court upholds the ACA but not the mandate, expect a flood of uncertainty about the future of health care in this country. The level of gridlock generated by that decision could create a wake of problems for all levels of government and the entire health care system not seen since Katrina.

A New York Times article by Jonathan Weisman and Michael Shear speaks to the level of groundwork happening on both sides of the issue. From the Republican National Committee to the National Republican Congressional Campaign to the Democratic National Committee to Families USA to America’s Health Insurance Plans, virtually everyone with a stake in the game is prepared for whatever comes and has contingency plans mapped out several moves ahead: “Since Republicans believe that health insurance companies are contractually obligated to maintain some of the most popular provisions, like allowing adults under age 26 to remain on their parents’ health plans or ending lifetime payment caps, until the next open insurance enrollment period, they contend there will be less pressure on Republicans to produce the “replace” part of their promise to “repeal and replace” the Affordable Care Act. Republicans say their view was bolstered by recent signs from the health insurance industry that they will retain some popular benefits.”

According to Wehrle, regardless how the court decides, “It is difficult to imagine a system where everyone has a right to receive benefits but no corresponding obligation to participate in the financing of that system: See Greece.”

Whatever the court decides, it will affect all 50 states equally; however, there will be differences in how individual states respond to the decision—including a plethora of possible policies and programs.

As an uninsured cancer survivor with a pre-existing condition living in Colorado, what most concerns me is how the court’s decisions will impact my medical choices and my level of access to care here in my home state.

According to a March 2012 report from healthcare.gov entitled “Two Years Later: The Benefits of the Affordable Care Act for Colorado,” “The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.”

The report also maintains, “Thanks to the new health care law, 42,580 people with Medicare in Colorado received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in 2010. In 2011, 39,476 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount resulted in an average savings of $579 per person, and a total savings of $22,846,993 in Colorado.”

It goes on to add that 973,000 Colorado residents received preventative care without co-payments, 1,432,000 will receive more coverage for their premium dollars, and 1,902,000 have already had lifetime limits on coverage lifted.

While these advances are important, the government’s report makes no mention of those who are still missing from the health care equation. For example, there are 1.5 million medically underserved/underinsured in the state and almost 829,000 without health insurance (16 percent of the state’s population, on par with the national average)—including about 318,000 18-34 year olds and the approximately 300,000 Hispanics.

“In my opinion, that’s way too many people,” said Gretchen Hammer, Executive Director for the Colorado Coalition for the Medically Underserved.

Why is not having health insurance such a big deal? First, consider the cost shifting that occurs when uninsured people need immediate care for conditions that could have been treated in a doctor’s office if caught earlier. The cost shift from uninsured individuals to emergency rooms and hospitals is eventually absorbed by people who have insurance. A 2009 study by Families USA found that uncompensated care costs impose a “hidden tax” on family health coverage of $1,017. Second, consider the conclusion of a December 2009 American Journal of Pubic Health report authored by Dr. Andrew Wilper et al, which stated, “Lack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease.”

According to Statereforum, based on seven criteria for readiness for implementation of the ACA, as of June 1, 2012, Colorado has only completed four of the criteria. Seven states (Mass, Md., Nev., N.Y., Ore., R.I., and Vt.) have completed six out of seven; six others plus the District of Columbia have completed five out of seven (Calif., Conn., D.C., Ky., N.M., Ala., and Hawaii).

On June 15, Peter Lee, director of California’s Health Exchange announced that California was going forward as if the ACA had been upheld. “We [aren't] doing anything in the way of contingency planning because it makes no sense to plan for what seems like an outer bounds of possibility, and rather, we’ve got a big job to do to get ready to cover what will be millions of Californians in 18 months,” Lee said to Capital Public Radio.

By contrast, Colorado’s official Web site for health insurance exchange news only says that it will be open late 2013; although, it does provide an implementation timeline for Colorado’s health insurance exchange. According to the federal government report “Two Years Later,” Colorado has received $18.9 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges, which are key provisions of the ACA.

According to healthreform.gov, if the ACA is upheld, on July 1, $90.3 million in federal money will be available in Colorado to help provide coverage for uninsured residents with pre-existing conditions (like myself). The goal of this program is to create a bridge to “2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions.”

The timing of this program’s implementation and the Supreme Court’s decision are too close for coincidence. If the ACA is upheld, then people like me, in Colorado and the other 49 states, will have access to health care through the federal government. Obviously, that $90 million comes from taxpayers that must be balanced against the medical cost shifting mentioned above.

“The information from other places that have gone from no mandate to a mandate—most famously Massachusetts under Romney—has been studied extensively,” said David Langness, Director of Communications for Health Care Reform at Kaiser Permanente. “The studies found that people who come into the health insurance system for the first time have a lot of deferred maintenance. … The expense of their treatment, combined with staffing up with new doctors and nurses and new infrastructure, those costs are most likely to offset any new revenues.”

Costs, constitutionality, benefits, civility, cost shifting, severability, precedence, the role of government… there are dozens of ways to analyze the ACA and none of them bring us any closer to predicting whether or not the Supreme Court uphold the ACA. It’s a massively complex issue, or the court would not have set aside six hours to consider oral arguments, which hasn’t happened in 40 years.

“To give you a point of reference, the Supreme Court only heard 1.5 hours of argument for Bush v. Gore.” said Langness.

From the perspective of an uninsured cancer survivor, what matters most is when will my government get in line will all other major industrial countries and support universal access to quality health care without restrictions or conditions or the threat of it going away.

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From March 26-28, the Supreme Court heard oral arguments about the constitutionality of the Patient Protection and Affordable Care Act, frequently shortened to the Affordable Care Act—or simply “Obamacare.” These three days of arguments were the most time the Supreme Court has spent on a single case since the 1954 Brown v. Board of Education decision.

The Affordable Care Act hearings focused on four main points:

1.  Authority: Does the Supreme Court have the authority to rule on the constitutionality of the Affordable Care Act’s penalty for not having health insurance before anyone is actually required to pay such a penalty (April 15, 2015)?
2.  Constitutionality: Can Congress require that virtually all Americans purchase health insurance or be forced to pay a penalty (which would be collected as part of an individual’s Federal Income Tax)? Does this “individual mandate” violate the Commerce Clause of the Constitution that regulates interstate commerce? In other words, is this law something new and different? If the court upholds the mandate that all American must buy health insurance, does the court have the authority to force us to buy anything from burial insurance to broccoli?
3.  Severability: Can the ACA’s individual mandate be severed from the rest of the law—or is the individual mandate so central to the law that finding this one aspect of the law unconstitutional mean that the Supreme Court must strike down the entire law?
4.  Medicaid: Is it coercive for the federal government to require that states pay a portion of the costs of administering Medicaid—or lose federal funding for other federal programs.

The Court’s answer to this $2.6 trillion question is expected later this month. In the meantime, the 26 states that challenged the federal government and approximately 310 million Americans (50 million of which are uninsured)—not to mention a multi-billion dollar health insurance industry—continue to wait and watch.

Legal experts and political pundits far and wide have weighed in on the likelihood of the Affordable Care Act (and the individual mandate) being upheld or struck down by the Supreme Court. The prevailing thought is that the court has the authority to rule before April 15, 2015; however, the prospect of the court supporting the ACA’s constitutionality and the mandate’s severability is uncertain at best. (Whether the court upholds the Medicaid provision is also a topic for debate, but not nearly as hot an issue as constitutionality or severability.)

Conventional wisdom predicts that the four liberal justices (Breyer, Ginsburg, Sotomayor, and Kagan) will side with the law, the three conservative justices (Alito, Scalia, and Thomas) will rule against it, leaving Chief Justice Roberts and Justice Kennedy and as the swing votes.

Even though it is problematic to predict the outcome of the case based on oral arguments, the consensus of legal observes and journalists who follow the Supreme Court is that both Chief Justice Roberts and Justice Kennedy leaned visibly toward the conservative position on all four points, which would create a 5-4 majority against the ACA—or at the very least, against the mandate.

“Well, the same, it seems to me, would be true, say, for the market in emergency services: police, fire, ambulance, roadside assistance, whatever,” said Chief Justice Roberts on the second day of hearings. “You don’t know when you’re going to need it; you’re not sure that you will. But the same is true for health care. You don’t know if you’re going to need a heart transplant or if you ever will. So, there’s a market there. In some extent, we all participate in it. So, can the government require you to buy a cell phone because that would facilitate responding when you need emergency services? You can just dial 911 no matter where you are?”

Also on the second day of hearings, Justice Kennedy added his most telling statement, “When you are changing the relation of the individual to the government in this, what we can stipulate is, I think, a unique way, do you not have a heavy burden of justification to show authorization under the Constitution?”

Watching and Waiting

The media spectacle of analysis and prediction surrounding how the court will decide has taken on the look and feel of pre-game whoopla of a major college football or basketball rivalry. The principle difference between this “contest” and a sporting event, however, is that the outcome has likely already been decided.

While Las Vegas does not publically post betting odds for Supreme Court’s rulings, On June 2, Intrade, which calls itself the “World’s Largest Prediction Market,” reported 63 percent chance of the ACA’s individual mandate being overturned. As of June 2, shares of this prediction could be purchased on Intrade for $6.28 per share.

On June 1, FantasySCOUTS reported that approximately 55 percent of its audience believes that the individual mandate is unconstitutional.

Numerous pundits have chimed in on this issue, including Richard Kirsch, author of Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States and a senior fellow at the Roosevelt Institute who is also the former campaign manager for Health Care for America Now.

“The odds are that it’s slightly more likely to overturn the individual mandate,” Kirsch said in an FA article on June 1.

This perception is a stark shift from the pre-hearing American Bar Association poll that was reported in March 19^th issue, The New Republic. In that poll, 85 percent of lawyers, academics, and journalists who regularly follow and/or comment on the Supreme Court thought the court will uphold the ACA.

New York Times columnist David Brooks brought up an interesting moral point on PBS’s “News Hour” on March 30, that was not argued by the justices or highlighted in any poll. Brooks’ thinking goes back to the Old Testament question: “Am I my brother’s keeper?” In other words, is it in my best interest to live in a civil society where we collectively care for each other’s health and wellness needs? Conversely, is the cost for caring for the ill and aging too great for the young and healthy?

“I don’t pretend to pass judgment, but it strikes me as a perfectly valid constitutional issue,” Brooks said. “Basically, what the individual mandate does, it asks—it compels people to enter into a contract with an insurance company, which is not really in their best interest, in order to subsidize other people who are forced to enter into that contract.

“That strikes me as a step forward in executive or governmental power. So it strikes me as a perfectly legitimate thing to do. I can see why, morally, we are all responsible for each other’s health. We’re not going to let somebody die on the street.

“But, constitutionally, why the government should be compelling people to do this, that strikes me as a completely valid concern, and the justices honed right in on that one.”

Complete Severability?

If the justices strike down the individual mandate, it will no doubt be seen as a failure for President Obama. Striking down the mandate, however, might cause a Roe v. Wade style backlash among progressives, liberals, and independents that could sweep Obama into a second term. The tealeaves are hard to read at this point.

Without the mandate, it is difficult to imagine how the rest of the law can survive. For example, provisions of the ACA state that you cannot be denied insurance because of a pre-existing condition, nor can your insurer drop you if you become sick. If all Americans are purchasing health insurance, then there is enough money in the pot, so to speak, to cover everyone; however, if the only people paying into the system are sick people over 45, there won’t be enough money to cover everyone.

If, on the other hand, the justices uphold the individual mandate, then expect to see health insurance exchanges (HIXs) in all 50 states. Also expect these exchanges to offer a host of health insurance packages from a spectrum of providers. Some industry experts, who declined to be named in this article, estimate the costs of premiums will drop by as much as 30 percent below what most employers are currently paying for insurance through their employers.

Others, like Robert Zirkelback of American Health Insurance Plans, believe that the savings offered by volume buying at HIXs will be offset by the cost of health care increasing.

“Two things are responsible for the increase in the cost of health insurance: 1. The cost of health care itself—which has been going up every year for decades, and there isn’t anything in the law [ACA] to stem that growth; 2. New benefits, mandates, and regulations will only add to the already growing cost of coverage,” said Zirkelback. “If you want to improve the system, lower the cost of coverage and make it less. Don’t tax health insurance; instead, give people more choices and flexibility to buy the health insurance that’s right for them. Look into the cost of medical care. The biggest driver of rising health insurance costs is our out-of-control fee-for-service system. Doctors are paid for services, not improving patient outcomes and lowering the incidence of disease.”

According to David Langness, Director of Communications for Health Care Reform at Kaiser Permanente, “What we do know [if the ACA is upheld] is there will be influx of the previously uninsured into the health care system. If the predictions are right, this influx will be large. … There will be a large influx of patients into the system by primarily people who were previously uninsured.”

Langness bases his prediction on the states like Massachusetts where large populations of the previously uninsured have suddenly received health care, and immediately sought help with their “deferred maintenance.” According to Langness, if the ACA and the individual mandate are upheld, the big question will be: “Do we have enough health care professionals to address that need. In other words, what will it cost and who will do the work?”

The biggest sticking point of the ACA is requiring young, healthy people to purchase health insurance—and thereby subsidize older, sicker Americans. According to the Department of Health and Human Services, in 2010, 40 percent of Americans without health insurance were between the ages of 18-34 (18-34 year olds make up only 24 percent of the general population).

If younger, healthier people pay into the system, then there will be enough money to cover older Americans who are more likely to need additional care. If these younger people opt to pay the income tax fines for not purchasing insurance, then the system will not work. Or as Justice Ruth Bader Ginsburg put it, “That’s how insurance works.”

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