Leading article: Victory for fairness and civil values

The decision by the US Supreme Court to uphold the essence of President Obama's healthcare reform legislation is to be applauded as a victory for fairness, civil values and even sanity.

If the nine justices had ruled that the individual mandate – the provision requiring all Americans to purchase insurance coverage that is at the heart of the measure – violated the Constitution, it would have been an unwarranted intrusion of the judiciary into what is a political issue that should be decided by elections and Congressional votes.

More important still, they would have scotched the most promising effort in decades to overhaul a monstrously inefficient industry, which accounts for almost a fifth of the entire US economy, yet still contrives to leave some 50 million people without coverage and deliver results no better – often worse – than European systems consuming barely half as much of national GDP. As for Mr Obama, he would have gone down in history not as the author of a massively beneficial reform, but as a President who wasted most of his first term in pursuit of a chimera. The political and psychological consequences would have been devastating.

Even now, however, the battle is not over. Repeal of the Affordable Care Act, as "Obamacare" is properly known, will be a central theme of the Republicans' campaign to recapture the White House and Senate in November. If they succeed, then the measure will be overturned. And should that happen, Democrats can have no complaints. That is what elections are for.

The reform itself is still very much a work in progress. Some of its provisions do not even take effect until 2014. Almost certainly, parts of the law will have to be modified as unforeseen problems crop up. It may even be that the whole scheme proves either unworkable or too expensive, and that Obamacare will be remembered only as the precursor of some form of government-run single payer system. But with this decision, the US has taken another step towards joining the rest of the advanced industrialised world in providing health coverage for all its citizens.