In the span of one week, Democrats went from dismissing the possibility that the Supreme Court would strike down the 2010 law mandating individuals to buy health insurance to consoling themselves that any such action would have a silver lining.
James Carville says it would help the Democrats in the election. Washington Post columnist Eugene Robinson writes that it would make single payer – a government health system as in Britain and Canada – inevitable. Other liberals, and even the occasional right-of-center analyst, have echoed that point: The conservative legal challenge to President Obamas health-care overhaul could prove self-defeating.
Its an interesting and counterintuitive analysis, but its almost certainly wrong. If the court undoes Obamacare, either in whole or in part, conservatives who would like to reduce the governments role in health care are likely to get policies much more to their liking.
Lets say the court strikes down the entire law. The Democratic fantasy goes something like this: The public will still be upset about the number of Americans without insurance, rising premiums and the difficulty people with pre-existing conditions have getting insurance. Republicans will have no plan for achieving universal coverage. Sooner or later, single payer – which would probably be more popular than a mandate, and thus an easier sell to the public – will prevail.
Reality-check time: When Obamacare became law, Democrats had more power in Washington than at any time since the Carter administration in the 1970s. They had the presidency and lopsided majorities in both houses of Congress. Because conservative Democrats have declined in numbers, it was probably the most liberal Congress since 1965-66. They were still barely able to pass the law. And that was with important medical industries either neutralized or in favor of the legislation, which they would not be in the case of single payer.
Democrats attained that degree of power because of an unusual set of circumstances: an unpopular Republican president reaching the end of his second term and a financial crisis hitting at exactly the right time. The odds are that it will be a long, long time until Democrats again hit the jackpot. And without an overwhelming Democratic majority, getting single payer through Congress would be almost impossible: Republicans wont acquiesce to such a system.
Its true that people like the idea of helping the uninsured and those with pre-existing conditions, but the support melts away when this help involves higher taxes or intrusive regulation. Look at it this way: For several years, fans of the health care law have been saying that any day now the popularity of Obamacares regulation of insurance companies would start trumping the unpopularity of other parts of the legislation. It hasnt happened yet, and there is no reason to think it would once the court struck down the law.
Or lets say the court strikes down the mandate, but leaves in place the insurance regulations. The regulations without the mandate would lead healthy people to drop their coverage – the insurance rules mean such people would be able to get it again if they get sick – and with only ill people covered, premiums would soar.
The question then becomes: Would Congress be more likely to respond by moving to single payer or by getting rid of the regulations?
We have seen just this scenario play out in a number of states that imposed similar regulations without any mandate. Iowa, Kentucky, New Hampshire and South Dakota have all repealed their regulations, while Maine, New Jersey and Washington have weakened theirs. Only liberal Vermont, according to a study conducted by Americas Health Insurance Plans, a trade group, has moved toward single payer.
In those cases, of course, the Supreme Court wasnt involved. Democrats would be outraged if the court struck down the mandate, and would presumably blame any resulting problems in the health care market on its decision. Republicans, meanwhile, would blame the Democrats for enacting a flawed law that couldnt survive legal scrutiny.
The public is likely to side with the court, for two reasons. Americans express significantly more confidence in the court than in the presidency or Congress. And most Americans dislike the individual mandate and actually want it struck down.
None of this means conservatives will get their way on health care policy across the board. Presumably, Democrats will continue to resist Representative Paul Ryans plan to transform Medicare, or a revival of Sen. John McCains proposal to let people buy insurance across state lines and give them tax credits. Many liberals think those policies would be just as disastrous as most conservatives think Obamacare would be. But such reforms seem at least as likely as single payer to make headway. And Obamacares demise would clear the way for them.