In a State of the State address for Maryland many years ago, Robert Ehrlich articulated a sentiment that is succinctly summarizes the aspirations of a majority of Americans: “Every Maryland family wants financial security, schools that work, quality healthcare, safer neighborhoods, and ever-expanding economic opportunity. These are the building blocks of a superior quality of life.”  While there are an infinite number of deviations from what ‘every Maryland family’ wants in the wild potpourri of American inclination, he managed to hit on many of the common denominators that constitute the basic needs and desires of the American family.  Years later, we are still trying to decide how to achieve these basic needs.  Part of this decision will play out in the Supreme Court in coming weeks, as the assembled head of the United States judiciary branch weighs and determines the constitutionality of Obama’s healthcare plan—variously know as ‘Obamacare’ and less commonly known as the Patient Protection and Affordable Healthcare Act (PPACA).  There are some names for this plan that are better left unmentioned.

Whatever you prefer to call this plan, all the names point to the same basic initiative: “the President’s healthcare initiative to cover all Americans.”  It’s a plan that has met with staunch opposition from the time it was in rough draft form in legislative committees.  A sequence of lawsuits suits focusing on the “individual mandate” portion of the law has blazed a trail through various state courts during the past few months.  In the first quarter of 2011, more than half of the United States embarked on lawsuits fighting over the federal mandate, claiming it effaced various essential and constitutional state policies.

Now this drama approaches its climax.  In an effort to streamline the process and face up to the inevitable, State courts have deferred directly to the Supreme Court to determine the cases’ constitutionality.

At the core of this controversy is one burning issue: the unsustainable, and crippling cost of healthcare in the United States. Various critics say argue that the price of health care simply too high to be sustained by many Americans, while their opponents refuse to accept a mandate from Washington that creates a mandate for all Americans to throw money into the pot or pay a penalty fee. Both sides have complicated and informed reasons for holding to their positions, and both have the same ultimate goal in mind: reducing the cost of healthcare.

It is important to remember that whether you support or oppose this plan, the solution to the problem is not ideological.  Whether we attempt to reform Healthcare, by a federal mandate, or according to the internal logic of the market, the improvements will be made up of millions of quantum innovations and improvements to systems and methodologies.  In order to move the mountain, we will have to beginning shifting its mass one parcel at a time.

Smaller medical practices struggle with the cost of equipment and need to reduce the overall cost of doing business in order to adapt to a terrain where many Americans are operating with reduced incomes and fewer people have health coverage offered by their employers. Even a series of small changes can impact income significantly. From changing methodologies, to changing the relationship of doctor’s to health care providers which often create incentives for extra, unnecessary procedure, all the way to implementing more efficient medical billing software—all of these incremental changes will need to unfold to reduce the overall cost of the business end of running a clinic.   Many of these changes are likely to be seen enacted in Obamacare itself.

Some doctors worry that one of the ways PPACA will affect the economy will be to make it more expensive for doctors to do their job. Some hospital organizations have begun to purchase smaller practices in order to specialize, but this can actually raise costs rather than reducing them. Software innovations that streamline these practices could run parallel to Obamacare, in an effort to cut expensive procedure from the operating costs of larger hospitals and smaller practices.

One of the stated aims of Obamacare is to reduce the cost of healthcare for all Americans. That means that reducing the price-tags on some procedures but also trimming fat in administrative waste.  Given the money-saving potential inherent in this sort of thing, implementation of new policy like effective, efficient software or greener standards may be a part of how Obamacare is implemented. This would slough of a major percentage of the waste generated in clinics (i.e. excessive paperwork, inefficient billing protocol) that leads to inaccurate invoices, unpaid bills and a number of other encumbrances that ultimately affect the bottom line.