Watching the lawsuits that are challenging the individual mandate provision of the Patient Protection and Care Act (PPACA) has become the new health care thrill ride. There are ups and downs; it is alternatively exhilarating and frightening, knowing we can’t foresee what lies ahead. Just like a roller coaster ride, our attention is riveted — even though we know the ride will end at the U.S. Supreme Court. We didn’t volunteer for the ride, but here we are, strapped in and terrified.

In chatting with friends both inside and outside of the industry, there doesn’t appear to be a whole lot of wiggle room in the positions that have long been staked out and hardened. Proponents of the mandate — indeed, of the health care law writ large — make very impassioned and reasoned arguments in favor of the results it will yield.

The problem is two-fold. First, theirs is a largely idealistic “ends justify the means” approach. Second, their positions (by and large) have little or nothing to do with the underlying constitutional issues.

William F. Buckley Jr. once opined, “Idealism is fine, but as it approaches reality, the cost becomes prohibitive.”

The ideal of a more egalitarian health care system is a fine and worthwhile aspiration. The real question, as is almost always the case, is how we get from here to there, and, as Buckley correctly asks us to consider, at what cost?

In other times, this dichotomy would have been resolved by working together diligently to find real solutions that don’t erode the constitutional underpinnings of our society. It seems, however, today’s zero-sum, hyper-partisan environment has sucked the air out of those opportunities. In the end, that may be the greatest cost of all.

Check out more blog entries from David Saltzman.