Conservatives are predictably pillorying Chief Justice John Roberts as a traitor or worse. But constitutional arguments aside, anyone who understands health policy and insurance markets knows that Roberts’s historic hand on the scale Thursday was the only way to preserve a central role for private insurers in American health care in the years ahead. In this sense, Roberts’ epic choice is therefore not only small “c” conservative as a matter of judicial temperament but economically conservative to boot. What the chief justice has done is nothing less than save shortsighted partisans bent on overturning Obamacare from themselves.
As I and others have long argued, a successful drive to overturn the Affordable Care Act, combined with a continued surge in the ranks of the uninsured, would almost certainly have put America on a path to a single-payer system, about whose constitutionality there has never been any doubt. The only way to move toward universal coverage via private health plans is to require everyone to be in the insurance pool and to offer subsidies to lower-income folks who’d otherwise be unable to buy a policy. Conservatives understood these facts and supported this approach until President Obama decided to adopt their ideas and put real money behind them.
There are therefore so many policy ironies accompanying Thursday’s decision that its hard to keep track. The left is (rightly) cheering the vindication of Romneycare, which the president now has a legal green light to take national. Mitt Romney is assailing his own pioneering policy and vowing to scrap it at the federal level if he gets the chance. And Roberts is being trashed by supposed champions of the private sector, whose role in health-care finance has in fact been preserved by Roberts’s surprise switcheroo. That may not have been the chief justice’s intent — his real motives and reasoning in this historic exercise of power may be known only to his wife — but it’s the result. If conservatives had any sense of their long-term interests they’d be thanking him.
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