The Supreme Court decision to uphold the constitutionality of the Affordable Care Act (ACA) will have predictable political consequences and undoubtedly waste a lot of time and money that should be spent making the ACA work as Republicans seek to attack it and the Administration defends it. The first Terminator film comes to mind where, just as the heroine appears to have killed the machine from the future, it rises from the dead and keeps on pursuing her. Republicans, obviously quite chagrined about the George W Bush appointed chief justice being the deciding vote on the question of constitutionality, now threatens to storm the ramparts of Congress a 31st time and ‘repeal the law’. They lost the first 30 attempts. Repeal it with what; the Romney-initiated Massachusetts plan that was more radical than the early Obama plan and was more aggressive about universal coverage including a mandate for everyone to be in the system or face a penalty? That Massachusetts is now nearing universal coverage and is aggressively controlling costs in a state full of medical centres that don’t usually demonstrate technological restraint should make it hard for the Republicans to pick out anything that really makes sense NOT to do in the ACA. Finally, the fact that financing for expansion of health care nationally will come in a large part through higher taxes on the wealthy — which would include a lot of doctors — is particularly galling to Republicans, since the wealthy are the major funders of their efforts to unseat the president. But polls are turning …