Today the U.S. Supreme Court largely upheld Obama’s healthcare law — perhaps you’ve heard? We asked some smart people what they think it means for sustainability, democracy, and America. Here follows our first batch of responses (and a second batch is here).

Raj Patel, author of Stuffed and Starved and other books

Although Wall Street seems to be punishing the decision with a sell-off, the health-care sector has been buoyed by the Supreme Court. All stocks are up (except drug companies). Now that the insurance industry knows it’ll have a multi-billion-dollar market of mandatory customers, the industry won’t have to spend all that money to buy a different political decision, and it never has to worry about single-payer health care again. And that’s the tragedy of the debate around the health-care plan. In all the noise around this ruling, we can’t hear the voices demanding a cheaper, better system that dispenses with insurance corporations. The U.S. already spends more per capita than any other country for worse care. The ruling entrenches a bad system. The media circus drowns out discussion of a better one.

Terry Tempest Williams, author of When Women Were Birds and other books

As an American citizen who has been engaged fully in medical issues throughout my family’s history of cancer and illness, many of whom are not insured, this is a bow to those of us who look for a government that exercises compassionate leadership.  People are suffering.  They cannot pay their bills, let alone medical bills, hence they go untreated or compromise their health in the name of economic necessity.  Finances come first, health comes second. Short-term gain that yields long-term consequences.

The Supreme Court today acknowledged that Obamacare is a step forward in fixing a broken system that too often favors insurance companies and pharmaceuticals, rather than “We, the people.” Good news. And a surprise, regarding Justice Roberts: a small hairline crack of hope in the activist conservative court.

A fully functioning democracy must fully recognize the fundamental rights of its citizens. Health care for those in need is one of these rights. But it does not end there — a healthy society depends on a healthy environment. Clean water, clean air, and open spaces are part of an overall deepening of our definition of health.  Nothing exists in isolation.  Democracy depends on the understanding of engagement, protecting and preserving the integrity of an interconnected and interrelated world.

We have made the mistake of confusing democracy with capitalism, intertwined with a political machinery that we all understand to be corrupt. Competition in the health-care profession ultimately results in compromising the needs and vitality of each patient.  Who benefits?  The drug companies and the powerful lobbyists and politicians behind the pharmaceutical industry.

Today’s ruling is a ruling in favor of each American’s right and dignity to be treated fairly when ill, to be cared for when sick, and to avoid the endgame of despair and debt.

Gary Cohen, president and founder of Health Care Without Harm and Practice Greenhealth

The Supreme Court decision paves the way to dramatically expand the number of insured Americans. This sets the stage for the more fundamental reform of transitioning from an expensive disease-treatment system to one that addresses the environmental and social conditions that are contributing to the epidemics of cancer, obesity, diabetes, heart disease, and asthma in our society. We can no longer support healthy people in an economic system that is addicted to fossil fuels, toxic chemicals, and industrialized junk food. The health-care system, which represents 18 percent of the entire economy, needs to model the transition to an economy that supports healthy people in healthy communities. This is the only way we are going to control health-care costs and reverse the epidemic of disease in America.

Richard Heinberg, author of The End of Growth and other books

America’s healthcare system will become increasingly dysfunctional as the global economy lurches from decades of growth toward an inevitable period of contraction. The Obama healthcare law can’t fix all the worsening problems with the private insurance system (which could well be bankrupted by the next Wall Street meltdown), but if SCOTUS had overturned it, the consequences for millions of ordinary Americans would have been dire. What’s really needed, though, is a fundamental rethinking of health care to maximize community resilience and reduce dependence on centralized pharmaceutical, energy, finance, and transport networks.

James Howard Kunstler, author of Too Much Magic and other books

The American healthcare system is fatally distressed either with or without Obamacare and in many dimensions, ranging from the poor lifestyle choices of the people themselves to the racketeering that is now standard practice involving insurance companies, Big Pharma grift, and clinical hyper-specialization. I believe it will implode one way or another, under its own evil weight. Perhaps if we did not engage in foreign military adventures, and closed down a lot of our overseas bases, we could afford a single-payer system — but that is not at issue here, and probably unlikely to happen.

I also suppose that today’s decision will go down badly in the financial markets and in the business sector, which is also waiting fretfully for the so-called “Taxmageddon” adjustments scheduled to arrive in January 2013. The burdens to small business especially could be grievous. I write this as a registered Democrat, not a right-winger.

Eventually, we are heading toward a much reduced, downscaled local clinic system for health care in which far less high-tech medicine will be practiced on a pay-for-service basis. People better learn how to take care of themselves or they will perish.

We should be fortunate enough to remember the germ theory of disease and remember to wash our hands.

Read more reactions from sustainability thinkers.