Get ready for a few more years of uncertainty.

As you probably already know, a federal judge in Virginia was the first to rule that the big health care overhaul bill was overreaching in its authority. U.S. District Judge Henry Hudson said that the federal government can’t force individuals to buy a private insurance product, which was one of the main complaints by conservatives and libertarians.

Many of them were cheering, but maybe they shouldn’t celebrate just yet. The point of requiring people to own insurance was to expand the pool of insured individuals to include healthy people who currently aren’t paying. And when those people get sick now, a lot of them skip out on the bills, to the tune of $43 billion per year.

Guess who pays those costs now? Me, along with everyone else who pays higher insurance premiums and medical costs to offset those losses. So I’m not so excited about this ruling, even though I generally don’t like the guv’mint requiring me to do anything.

This judge’s ruling will be appealed, and hopefully will get to the Supreme Court sooner rather than later, so we don’t have to live with too much chaos over our insurance premiums.

The rest of the health care law is intact, so insurance companies will still have to accept anyone who applies for insurance. Enterprising healthy people will simply wait until they are sick or injured to finally start paying into the system. That means higher insurance premiums for the rest of us until the problem is fixed.

While I personally agree with the constitutional arguments in the judge’s ruling, as a practical matter it’s going to make life difficult for us in the meantime. We’ve been fighting a nasty verbal war over health care reform for the past year, and we still haven’t answered the toughest question about health care; how should we pay for it?

Different countries have different answers for this question. But at the end of the day, we’re all paying for it, either through taxes, fees, or insurance premiums.

If everyone simply paid their own medical bills directly, there wouldn’t be a financial problem. No insurance companies, no Medicare, no Medicaid, no federal deficit spending, and cash is king. If you can’t pay, you get turned away.

But we don’t like that system; it seems cruel that we should just condemn people to suffer, die, or go into crippling debt because they can’t afford the cure. So instead, each country has their own custom mix of government funding, private insurance, and self-financing ways to cover medical costs.

Everything we’re arguing about today is the balance between these three methods. Both parties in Congress have different ideas for how the formula should be applied to get the best results for the least amount of money.

It’s a difficult task, especially given the explosion of medical costs over the past couple of decades. Back when Lyndon Johnson was president, he was given nitroglycerin pills to take after his heart attacks, and told to stop smoking. Today, he might have also been put on statins and hypertension drugs, undergone an angioplasty (using a tiny balloon to widen an artery), or perhaps even bypass surgery, which was uncommon back in 1972.

All of these new procedures are adding up to a very big bill, and someone’s gotta pay that bill. Heart care alone cost us just over $400 billion in 2009.

These new drugs are getting more expensive too. A survey from 2006 shows that the estimated average cost to develop a single new drug ranges from $500 million to $2 billion. You might not be taking that little blue pill, but it gets added to the huge mass of medical costs that are ultimately paid for by you and me.

These costs are unsustainable in the long term, and we’ll have a new set of tough questions upon us soon. Most importantly, how much should we spend to extend life?

We can all agree that spending $1 million to extend someone’s life for 24 hours is probably wasteful, if that person has no chance of living beyond that single day. We can all agree that spending $10 to extend someone’s life for 10 years is worthwhile, so the final answer we’ll compromise on is somewhere in between.

Constitutional questions are important, but we have far more important questions to answer.