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As the U.S. Supreme Court prepares its decision on the landmark health care reform law, conversations about health care are happening just about everywhere, from the grocery store to the corner caf, in big cities and in small towns. And the reason is simple:

"Health care in America is now unsustainable," says Don Berwick, former administrator of the Centers for Medicare and Medicaid Services. "What we know is health care can be a lot better than it is and lower cost by changing health care to be more responsive to patients.

Berwick became Medicare chief just six months after the Obama Administrations health reform law passed. During his almost 18-month tenure, he implemented many of the earliest provisions of the Patient Protection and Affordable Care Act, including coverage for those with pre-existing conditions, and the introduction of no-cost preventive care such as check ups, cancer screenings and immunizations for Medicare patients.

Berwick is among many leaders in the health care field who believe reform is now on a trajectory that wont be stopped, no matter the justices ruling.

Whether that law survives or not, the ship has left the port," he says. "Theres so much change in this country, in the private sector as well as the public sector. Doctors, hospitals, nurses everyone knows that care needs to change to better meet the needs of patients.

Joel Hay, a professor at the Schaeffer Center for Health Policy and Economics at the University of Southern California, agrees. He points out that medical costs now devour 17 percent of our Gross Domestic Product. Put another way, those costs have consumed all pay increases given to working-class Americans during the past two decades.

"The average American is not gaining ground in terms of take-home pay precisely because health care costs are out of control," says Hay, who opposes the Affordable Care Act as too unwieldy and complex. Instead, he proposes a different plan:

"Instead of having an enormously complex plan that is run out of Washington... we (should) allow the states to experiment on their own. Let them take charge of their own systems to figure out something that will work a lot better."

Governor Edmund G. Brown, Jr.'s administration says thats exactly what it plans to do should the Supreme Court deem the federal health care law unconstitutional. However, the shape a California health care plan might take isn't yet clear - especially in light of the states $16 billion budget deficit.

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Health care reform trajectory won't be stopped by Supreme Court ruling