Should the Supreme Court strike down the "individual mandate" provisions of the ACA, there is a lot of speculation about how workable the ACA is without it. The Supreme Court is considering this issue within the context of its constitutionality. For me, there is no question: The mandate is clearly and unambiguously constitutional. However, my position on the policy and politics of it remain the same: It is bad policy and even worse politics. However, considering that the ACA is what we''ve got, and its got a lot, I'll take it. But it certainly isn't popular. It is proving difficult to implement because of its complexity. It could have cost us a body of Congress. And now its being prosecuted in court. Hard to call that it a rousing success all things considered.
But lets take a step back a minute and look at the big picture: The ACA, for all the love and efforts Demcorats put into enacting it, is a conservative healthcare reform. It's roots, as we all know, come from the Washington conservative establishment of the early 1990's. Just ten years ago, it was the standard go-to reform for conservatives looking to intervene in the healthcare system. That is why an ambitious Mitt Romney, seeking to win over the conservative establishment in his quest for the presidency, adopted it as the model for healthcare reform. That is why we are now tying our healthcare reform to the Republican nominee, a rather striking and in my mind very disconcerting development.
Well, now we find ourselves betting the farm on a conservative leaning Supreme Court. They'll either cementin place or dismantle a conservative healthcare reform bill. In other words, if this or a similar bill were pushed by President Bush in 2003 with a Republican Congress, we'd probably be on the opposing side of that which we now advocate.
So what if the Court strikes down the law? Where does that leave the Democratic Party on healthcare?
Quite frankly, it leaves us the only solution that makes sense, covers everyone, cuts costs, cuts bureaucracy, boosts the economy, promotes labor mobility, cuts business expenses, increases wages, is simple to implement, is clearly constitutional and will work: Medicare for all AKA single-payer.
Republicans have obviously gone so far off the deep end, they simply have one solution, which was basically pointed out by Alan Grayson: go somewhere and die if you cant afford your own healthcare. We will still have a problem with healthcare. Somebody will have to do something about it.
The only other option, which I'm sure the insurance companies will love, is for the Republicans to fall back on a state by state version of the ACA. I have no doubt that this will create an even bigger national mess than we have now. Even Republicans will start to budge after the bodies start piling up and a systemwide breakdown in basic care will start fanning the flames of the middle class rebellion.
Ultimately, I believe the Court will uphold the law and we'll be stuck with it until we get wise and do this thing correctly. But the Court does not have to do that. They can do whatever they want. If they choose to strike down the law, Democratic politicians will have to start reassessing what comes next. That next thing should be what should be done if we had a rational political system in this country: a national system of public health insurance paid for with taxation.