“And when you gaze long into an abyss, the abyss also gazes into you.”

— Friedrich Nietzsche, 1886

If a poll reported Tuesday in The Washington Post is correct, 30 percent of Americans do not know that the U.S. Supreme Court has ruled that President Obama’s health care plan is constitutional.

The Pew Research Center’s survey also showed another 15 percent of its respondents thought the court had overturned or greatly modified the law.

Thus, 45 percent of the public was either wrong about, or unaware of, a vitally important decision upholding a law that will alter the way health care is provided to 100 percent of Americans.

Thus, they are also likely unaware that, no matter what anyone says about “savings,” the Patient Protection and Affordable Care Act will raise annual costs by tens of billions of dollars and balloon the health care bureaucracy.

There’s something else many Americans may not know: Any expectation of privacy between a patient and a physician is likely going to vanish.

Detailed patient records will not only be shared with insurance providers, but with bureaucrats galore, not only concerning payments but with panels empowered to determine what treatments are appropriate in specific cases.

Let’s take the size question first: Fox News’ Jim Angle reported Tuesday that Rep. Denny Rehberg, R-Mont., has noted that the federal Department of Health and Human Services “was given a billion dollars in (Obamacare) implementation money,” and “that money is gone already on additional bureaucrats and information technology programs.”

The law will require “thousands of pages of regulations — an effort well under way,” Angle said, with 13,000 pages already written.

As columnist David Brooks said in Monday’s New York Times, the law creates at least “159 new federal offices, boards and councils, though nonpartisan researchers have had trouble reaching an exact tally.”

And the law offers strong incentives for companies to drop coverage for their workers, forcing them onto state “exchanges,” with a House committee saying “71 of the Fortune 100 companies have an incentive to drop coverage,” Brooks said.

He added that the Congressional Budget Office, though vague about definite numbers, estimated that up to 20 million people could potentially lose coverage. And when have government estimates about new health care programs’ costs ever erred on the low side?

So much for Obama’s promise that “If you like your present insurance, you can keep it.”

The law could also put up to 84 million Americans on Medicare, up from about 50 million now, something Brooks calls “an astonishing burden on that already stretched system.”

The crowning touch is that Obamacare turns collecting the taxes that Americans must pay if they choose not to be insured (a choice millions of us freely make today) over to the friendly folks at the Internal Revenue Service.

The IRS will hire at least 4,500 new agents for that purpose, spending $304 million on the effort.

And regarding privacy: Liz MacDonald, reporting for Fox Business, says that the new legions of IRS agents will now be charged with determining total family income for the purpose of collecting health care taxes, too.

It can then share that data with health care officials, with the IRS telling MacDonald, “We expect even more lien and levy powers.”

The federal Office of the Taxpayer Advocate says that Americans will now have to give the IRS:

1) Specific insurance data, including persons covered and the dates of coverage;

2) Any employer-offered coverage;

3) Details of any tax credits for coverage;

4) And any coverage waivers offered by the government.

But that’s only the financial side. While mandatory computerization of treatment details can improve care, it also enables a wide expansion in the range of people eligible to see specifics about Americans’ medical problems, no matter how personal (including mental health data).

Promises have been made that identities will be safeguarded, but how much can we trust faceless bureaucrats? And hackers have been able to easily compromise credit card information held by supposedly “secure” private systems. Will federal ones be any better — or even as good?

However, Obama’s chief of staff, Jack Lew, was wrong when he said this week that the Supreme Court has issued “the last word” on Obamacare.

In a Newsweek poll taken after the court’s ruling, voters gave Obama worse ratings on his handing of “health care” (disapproving by a 58-37 percent margin) than on the deficit, the overall economy, job creation or foreign policy (the last being the only area where he got a positive rating — and that by only one point).

Mitt Romney and the Republicans would be wise to make Obamacare’s “repeal and reform” a campaign centerpiece, informing Americans that by electing them we have one more chance to avoid the fiscal and privacy disaster looming over us.

M.D. Harmon, a retired journalist and military officer, is a freelance writer. He can be contacted at:

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