NEW YORK — NEXT month will see the second anniversary of Barack Obama’s health reform. It is unclear whether it will celebrate another. It could die at least two different deaths. The Supreme Court will hear arguments against the suit in late March; the court could throw out the law by July. If that doesn’t kill it, then a Republican could be elected president and scrap the law immediately after his inauguration. By that time, however, America’s health system may have already changed for good.

Nudged by the provisions of Mr Obama’s law, private-sector firms have been reforming themselves. Virtually every insurer and hospital is trying to make care better and more efficient. In many cases their reforms go well beyond the law itself. No-one, however, is staging a bigger experiment than UnitedHealth Group. This is partly because United is an insurance goliath. It had $102 billion in revenue last year and provided cover to more than 34m people, equivalent to the population of Canada. But it is also because it is unveiling particularly bold policies.

An insurer seems an unlikely crusader. United, in particular, has had a long, acrimonious relationship with hospitals. But given its heft, the company’s policies matter. […]