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.
For more on the Supreme Court ruling: