The bill was never about increasing the distribution of health care, at least not any time soon. The goal was always to take control of the health industry and then change it over the next 10 to 15 years. As far as constitutionality I'm sad to say it almost doesn't matter any more. The constitution is no longer seen as a set of rules and boundaries for the country. It's now something to be used when it works for the bill you wish to pass, or something to be rationalized around when it doesn't. I believe very few people in our government believe in fidelity to the law.