As a practicing physician and someone involved in hospital administration, I have to say the Supreme Court’s decision Thursday really never mattered because none of the choices that the Court was contemplating would have improved our current system of health care. Medical costs will continue to rise and ultimately what will likely happen is in programs like Medicare and Medicaid, people are not going to get very efficient health care.

These programs will continue to expand despite this ruling because our economy is broken. In 2011, Medicare covered 48.7 million people – an increase of nearly 5 million people over a five-year period. Meanwhile, more than 50 million people currently rely on Medicaid – an increase of nearly 8 million people in five years.

I don’t expect things to get any better. The rates of unemployment and lack of new hiring or small business starting up will lag on for years. And because insurance premiums are already so high and will likely continue rising, more people will end up on Medicaid and increase the financial burden on our debt.

If you don’t think this is possible, just look at what happened to our food stamp program: In 1990, there were 20 million people on food stamps. Those numbers dipped by 2000 to 17.1 million people, but now we’re up to a record high of 44.7 million people on food stamps -- an increase of more than 25 million people in 11 years.

Under the present conditions, our medical system is going to have a very hard time moving away from practicing defensive medicine, which goes against the grain of what the federal government is trying to do in encouraging preventive health care and wellness programs.

Physicians and hospitals will continue to look over their shoulders and worry about liability and their reputations. Especially when the game is rigged. The odds are stacked against them.

Let’s face it – federal health care regulations are like playing in Las Vegas. The house will always win. Most federal surveys about quality and patient satisfaction are designed to think that the patient has a voice in improving quality, but rather the results are calculated to cut costs, always against the back of physicians and hospitals and that will ultimately weaken the system and disenfranchise health care workers.

There is a massive deficit of nurses in this country, and it is also projected in coming years the U.S. will have a deficit of thousands of primary care physicians as well. If you look at most new medical students, they don’t envision their lives as the simple doctor in their community with a private practice, knowing all their patients and caring about their communities. But rather, they see themselves as employees of a socialized system, just doing what they’re told and having very little input in their future. This type of physician development will not create the type of entrepreneurial and innovative spirit needed to keep making further advances in medicine.

Hard choices need to be made in the near future. But this time around, nobody won.