If there is a legitimate challenge to the law, my hunch is that it is likely to come over the question of whether the individual mandate is as narrowly drawn as possible to achieve its objective. If regulating the interstate market for health care requires regulating health insurance, and if assuring a healthy insurance market requires solving the problem of free-riders who drive up premiums and taxes for everyone else, then isn’t the solution to require everyone to buy “catastrophic” insurance?
Roberts asked that question twice, but got no satisfactory answer, either from the solicitor general or any of the other justices. The reason is that there is no good answer. The safer ground for health reform was always to base it, at least initially, on policies that cover major medical events such as a heart attack, a premature birth, or treatment of cancer or a serious chronic condition. Yet such an approach has always been rejected out of hand by liberal Democrats and powerful “disease lobbies” who were intent on finally achieving health-care coverage that was both universal and comprehensive. Now their over-reaching has not only driven up the cost of health reform and made it difficult to win broad political support, but has also put the entire law in constitutional jeopardy.