One of the overlooked elements in Thursday's decision to uphold the Affordable Care Act is that, beyond the individual mandate and the hysterical politics surrounding it, the act itself is chock-full of innovative ideas and pilot programs and all sorts of other experimental goodness directed toward making easier the lives of people dealing with serious health problems. Like, for example, Alzheimer's Disease. Stories that you don't notice on the news get me sitting bolt upright in my chair because I happen to have in this particular fight.

Tucked away in the act is a pilot program for 10,000 people called the Independence At Home program. This is a technique first developed by the Veterans Administration — motto: Single-Payer Works! Just Ask Us! — by which a patient with a chronic disease, like Alzheimer's, is treated in his or her own home by a team of doctors, nurse practitioners, geriatric pharmacists, and any other health professional whose specialty is required. This is not only cost-efficient, being infinitely cheaper than hospitals and nursing homes, but it is a comfort for the patients and their families, for whom familiar surroundings can be essential for psychological well-being. (Thrusting an Alzheimer's patient suddenly into a hospital is just asking for a track meet down the halls.) The program also recognizes the reality that a huge percentage of Medicare patients are suffering from two or three chronic conditions at the same time — Alzheimer's patients have heart disease, people with Parkinson's also have diabetes, etc.

"It was incredibly expensive," says one person involved in developing the program. "You had all these people with two or three chronic diseases, and nothing was coordinated. You literally had people showing up in emergency rooms with a paper bag full of pills. The problem was that nobody got paid for coordinating all the care."

The program also benefits from advances in technology. "Now," says this person, "you can put one of the diagnostic machines in the trunk of your Prius."

As we have said before, Alzheimer's is the joker in the deck of all health-care. Beyond the devastation it wreaks on individual families, its fundamental demographics absolutely blow up any proposal for a largely private health-care system. (There is nothing that Alzheimer's families find more sadly hilarious than the Medicare "reform" proposal dreamed up by zombie-eyed granny-starver Paul Ryan.) It costs in excess of $100,000 to care from an Alzheimer's patient from diagnosis to death and estimates are that, as the Baby Boom ages, there are going to be 15 million people with Alzheimer's in the not too distant future. Tyler Cowen rightly took a lot of heat over the weekend for arguing that we should just get past the fact that poor people are going to die. However, it's Alzheimer's that creates poor people, who then die, leaving their impoverished families behind.

The program is the brainchild of Rep. Edward Markey (D-Mass.), whose mother died from Alzheimer's, and who has been the head of the congressional task force on Alzheimer's since 1999. (Full disclosure: Markey and I are friends, and we have walked together in fundraising events to raise money for AD research on a number of occasions.) Markey was on tenterhooks along with the rest of official Washington yesterday, waiting for the decision to come down.

"Let's just start with pre-existing conditions," Markey told me on Thursday evening. "If the law had been struck down, you didn't have those protections anymore. And we know that five million people have Alzheimer's right now, and that 15 million are going to get it. Let's go to bankruptcy, then. The law says that just because you got sick, you cannot go bankrupt."

In a lot of ways, the fight over health-care reform has been a frustrating battle to get the country to accept by degrees the common sense of the thing as it plays out in our individual lives. Of course the crisis in health care is a national problem. Of course other countries manage to deliver quality health-care more cheaply and with better outcomes. Of course Alzheimer's patients are better treated at home, and with a team approach, to help manage symptoms they can no longer convey to their doctors or their families. Thursday's decision was a triumph for the plainly obvious.

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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