I have never had the fortune of feeling the nervous energy, anxiety and excitement of readying to play in the Super Bowl, the World Series or a World Cup soccer match – nor will I at this stage in my life.

But I can say that for three decades I have been part of the fight to realize the goal of quality, affordable health care for every American. Upon my graduation from medical school about 30 years ago, I pledged to join in the battle of health care for every American, and have experienced – along with many others – seeing hopes and dreams on this front dashed, derailed, delayed or deferred time after time.

As we anxiously await the decision of the U.S. Supreme Court on the fate of the Affordable Care Act, I worry whether we will still have a meaningful opportunity to begin realizing this dream. For those among us who have waited for so long, what hand will we be dealt by the Supreme Court?

Arguably, this is a once in a 50- to 60-year shot to fix our dysfunctional health care system, as we have not seen sweeping change since the arrival of federal Medicare and Medicaid in 1965. It is safe to say that no president in his or her right mind will take up this issue in earnest for many years to come – having watched the political bows, arrows and scars the Obama administration has weathered in trying to make the existing health system work better for America.

So, at the California Endowment – along with legions of advocates, stakeholders, consumers and health providers – we are feeling the anxiety and pressure of this moment. We cannot waste the opportunity to make our existing health system – or non-system – more accessible, more functional, more cost effective, more productive and more prevention-oriented.

As it stands, California has already taken critical steps to shift the health care system toward prevention and expand health care to millions of Californians. Since the enactment of the Affordable Care Act, California has secured hundreds of millions in federal funding that has been used to establish community health programs, create the Health Benefit Exchange and expand coverage to Californians with pre-existing medical conditions. Moreover, through the California Endowment's Health Happens Here campaign, and in conjunction with foundation and government partners, we've already enrolled thousands of Californians in new and existing health care programs.

If the Supreme Court votes to uphold the ACA, then we have no excuses. We must work as feverishly and assertively as we can to execute the provisions of the law to the greatest possible benefit of Americans who are uninsured, working class, small business or just plain desperate for access to quality health care. After all of the pain, fight and drama surrounding the ACA, failure is not an option in execution.

If the Supreme Court votes to invalidate the individual mandate – known as the minimum coverage requirement – but upholds the rest of the law, then California and the states have some work to do. Alternative policy strategies to make the private health insurance system work in the absence of a federal mandate must be explored and pursued, and with vigor.

If the court votes to deem the entire ACA unconstitutional, then we have some very quick work to do of our collective souls, hearts and spines. We will need to search our souls to digest the reality that the hopes of tens of millions of uninsured Americans – and millions more with the dreaded "pre-existing health condition" – have been dashed back to square one. We will need to find the heart to raise ourselves off the canvas to resume the fight. And we will need to find the spine and the will to keep pushing this boulder of an issue up the hill. The status quo is simply unacceptable.

This is because even if the ACA is deemed unconstitutional or otherwise politically torpedoed, the horse has left the barn on delivery system reform. There is simply no turning back, as the pressures of cost control on consumers, employees, businesses and taxpayers mount into an unsustainable force. So if the cost issue and market forces are conspiring to drive health delivery and financing reform anyway, we might as well use the reform momentum to actually fix the system so that it actually works for people.

So, in the final analysis, giving up, and giving in, are no option at all. Once the Supreme Court tells us what hand we've been dealt, even if it is a poor hand, let's play it well.

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