Regardless of how the court rules, the unfortunate reality is that the ACA won’t be able achieve universal coverage. It won’t make care affordable or protect people from medical bankruptcy. Nor will it be able to control costs. The ACA is fundamentally flawed in these respects because, by design, it perpetuates the central role of the private insurance industry and other corporate and for-profit interests (e.g. Big Pharma) in U.S. health care. In contrast, a single-payer system – an improved Medicare for All – would achieve truly universal care, affordability, and effective cost control. It would be simple to administer, saving approximately $400 billion annually by slashing the administrative bloat in our private-insurance-based system. That money would be redirected to clinical care. Copays and deductibles would be eliminated.