As you no doubt know by now a Virginia judge has ruled the provision of the health care reform law that requires that people buy insurance unconstitutional. If this ruling stands, which it probably won't, this makes health care reform basically impossible without constitutional reform.
It comes down to a problem that since the public isn't willing to simply let sick people die in the gutters and requires that emergency rooms treat patients regardless of ability to pay, everyone already has their health implicitly backed by the government. Let's call it Too Sick to Fail (to be treated at massive taxpayer expense). Of course, since this treatment is reserved for those that have become far too sick to be treated efficiently or, in many cases, to work to pay back even a fraction of their medical expenses, this becomes a very costly medical subsidy for those that choose to recklessly speculate on margin that their physical condition will stay sound enough that they can forgo spending on health care now to raise present consumption. They can do this knowing that if things go too badly they can rely on the government, and those moved with sympathy by their sob stories, to provide a level of medical care sufficient to prevent truly disastrous consequences.
Given that this implicit government and community backing has proven time and time again to exist, it simply makes sense to acknowledge its existence and make those covered by the implicit government subsidy pay for this backing and face the costs of it themselves, either through obtaining health insurance or through a national taxpayer funded plan, rather than being able to gamble that they can enjoy more consumption today knowing that if they do get sick they'll be shielded from the worst consequences by the tax dollars paid equally by those that bought insurance, who do not rely to the same extent on health care provided at public cost. This would have a further advantage in providing the means to pro-cyclically monitoring a person's health and perhaps catching a disease before it became both more costly to treat and more likely to prevent later recuperation of the costs through future income by the patient.
Or we can simply bury our heads in the sand and try to rule modern problems unconstitutional in an effort to avoid having to come to terms with the fact that our favored solutions can't fix modern problems.