Health reform repeal should make conservatives nervous

Early last year, I wrote that conservatives should have been happy with health reform.

Maybe they just didn’t realize it yet, because they’re rejoicing after yesterday’s news of a federal judge ruling the individual mandate unconstitutional.

But by supporting repeal, conservatives should be careful what they wish for.

The fact is, the Affordable Care Act is a moderate piece of legislation. There’s no public option. It leaves private insurers intact. There is no expansion of Medicare.  Many traits of the Act could be found in prior, Republican plans for health reform.

I agree with the Washington Post’s progressive blogger Ezra Klein in his analysis, where he cites a column by Matt Miller:

By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you’ll hasten the day when the public throws up its hands and says, “Just give us single-payer and price controls.” Don’t think the anti-government wave this fall won’t reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world’s costliest, most inefficient care.

Without the individual mandate, health reform cannot work. As Jonathan Gruber explains:

If insurance companies must charge the same price to people whether they’re sick or healthy many healthy people will view this as a “bad deal” and not buy insurance. This results in higher prices that chase even more people out of the market. The result is a “death spiral” that leads only the sick to purchase insurance at very high prices.

So, where will destroying the Affordable Care Act lead us? An increasing number of uninsured Americans and unabated, rising health costs. And worse, it is politically unlikely that anyone would address health care for decades.

Eventually, health costs would be so crushing, that the government would be forced to act — akin to their bailout of the auto industry. The most feasible solution then would be an expansion of Medicare, or Medicare-for-all — a true government takeover of health care.

That scenario is precisely why far left progressives want the current iteration of health reform to fail, which, strangely, is becoming a rare point that Tea Party activists and Huffington Post bloggers can agree upon.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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  • jsmith

    We all already knew that some judge somewhere would rule this way.
    The collapse of the current model will come with or without an individual mandate. I say this with no joy, but the leftists are correct when they say that this “reform” will have minimal impact.
    Let the lawyers litigate and the politicians posture, let them attempt rearrangement of the Titanic’s deck chairs. We health care insiders know the score. Reality always bats last. And reality means rationing big-time.

    • Vox Rusticus

      Exactly. Those who will celebrate the individual mandate defeat, if that is how the SCOTUS allows this to play out, will usher one of two outcomes: a state-by-state replication of the individual mandate, passed where there is support and defeated where there isn’t (with all sorts of strange echoes like some states making individual mandates unconstitutional, and the like) or further collapse of the present status by crushing premiums that will open the door for a single payer.

      And make no mistake, single payer will be buckwheats. For everyone. A federal government that cannot refinance its public debt will hammer forge a single payer plan that will sharply cut the expensive end of life care and significantly limit by payment and by CPT code what will be covered and exclude what will not. Congress, desperate to avoid “death panel” accusations will be only too ready to hand the ugly business of rationing–and this will be real, painful, efficient and expense-containing rationing–to any “non-partisan commission” that will take it. Such a commission will become a very powerful and very ominous development; if you think the IRS has a lot of power, you haven’t seen anything yet.

  • Max

    Why didn’t they just pass one bill: Force americans to buy health insurance. That would have been no cost to the government and would have allowed insurers to pay for pre-existing patients. I’m actually amazed at all the undermployed people who wanted this bill. I for one cannot wait until they see the bill come in the mail for their yearly insurance premium or face fines from the IRS. You wanted it people? You got it. Pay up and pay up now. I’m happy. More people are paying and I like when people have to pay.

  • Dr. Mary Johnson

    Even if a government-run, single-payer “solution” were mandated tomorrow, healthcare would still not be “fixed” until the leaders of this country grow the collective balls to do something about the huge, ugly elephant in the room.

    The elephant’s name is “Entitlement”. Anything goes – from the cradle to the grave.

    “No rules-no limits” simply cannot continue.

  • doc99

    Judge Hudson ruled that the individual mandate was an unprecedented use of the Commerce Clause and did not pass constitutional muster. It is anticipated that Judge Vinson will rule similarly in the Florida case involving 20 States. This is not about healthcare or insurance, it is about the power of the federal government. Were I Boehner et al, I’d get the CBO to rescore the ACA without the mandate. Yes, there will be blood.

  • imdoc

    I totally agree with jsmith. The whole delivery model will likely collapse. I am only surprised it hasn’t yet. The powerful entrenched stakeholders (hospital chains, health insurers, government, etc) will not yield one inch. My hope if that happens is we get something better in the aftermath and it is not a mediocre federally run system, but a product of free markets.

  • AA


    How are free markets doing to work since insurance companies don’t want to pay claims and look for any reason to drop you from coverage?

    Even if this is supposed to improve under the Obama Plan, your rates will be raised so high that you can’t afford coverage.

    I keep hearing we have the greatest healthcare system in the world but what good is it if it can’t be accessed and people can’t afford it? As one who has health care insurance with a very high deductible which makes accessing it difficult, I will take a mediocre single payer system any day.

    • Alice

      Obamacare had perks…so the premiums had to go up. Just insuring kids until an older age means everyone has to pay. Didn’t new regulation pass that means most of the income must go to claims now? Obamacare was going to ruin the free market…eventually, when seen through no insurance company can compete against the government. It is no longer the free market when the government is your competitor with such power to regulate you out of business.

      Also…please read Sally Pipes. Forbes lists her as one of the top 30 experts in the world on healthcare. The stats that place the US lower than other countries are not a true comparison. I can send through the bad comparison that is unrealistic. Think about it…what country has the neo natal units we have for premies? What countries can compare with common life flights to special units? What country has better equipment? Less wait times for tests? I believe your chances of surviving cancer here are better than anywhere, but the media picks up and irresponsibly prints stats that are not on a level playing field and yields a false impression.

  • doc99

    Interesting discussion of Judge Hudson’s ruling may be found here.

  • Maryann

    I often feel like a lone progressive reading this blog when most of the comments come from free-marketers. The free market in health care and insurance is serving no one except the very wealthy well. I guess these days that’s the American way.

    At present I live in Australia, where a government program covers every citizen and permanent resident (which means it covers me). It’s by no means perfect but basic preventive care is available and covered. Those earning over a certain amount buy a private policy that covers hospitalization, or pay a tax penalty. This coverage costs about $200 every two weeks for my husband and me, and also partially covers dental checkups, optometrist care, PT visits etc. Fair enough. I’m happy I can afford it, but if I couldn’t, Medicare would cover hospitalization and clinic visits. There are plenty of problems with health and health care but the foundation, while a bit shaky, is there.

    I am only a bit more than 5 years from (US) Medicare eligibility and I agree with Dr Mary J that entitlement is a big problem. I will be happy to contribute what I can toward my Medicare bill if I have the wherewithal to do so when the time comes. Why shouldn’t people who earn far more than I do so as well, according to what they can afford? Maybe then the truly in need could be covered.

    End-of-life care needs to be reined in, and coverage for assisted reproductive technologies as well. There, that’s my cranky not-so-progressive side coming out.

    AA has it right. Insurance companies are set up to deny claims and make profits for their shareholders. I support the expansion of Medicare with additional contributions for anyone over a threshold income. That won’t be perfect either, I have no illusions, and if it means I have to wait for non-urgent care, so be it. It has to be better than the current non-system we are so unreasonably proud of.

    • Alice

      The free market probably saved my daughter’s life. Under socialized medicine diagnosis and wait time may have killed her. Even with pur faults I will pay out of pocket for treatment here.

  • jim jaffe

    the real issue here isn’t how many people buy insurance, but how many services those who buy coverage consume and what it costs. if current consumption patterns hold — and the law bets they won’t — the entire system will crater whether there is a universal coverage or not. this is just a sideshow to avoid the really tough questions of how to provide effective care more cheaply.

  • Paul Dorio

    As doc99 said, the decisions being made are about the Constitution and how much power Congress and the President have or should have. Not that I am naive to the obvious politics of the matter, however. And I agree with kevinmd that this issue will potentially drastically affect health care costs.

    But surely there is another way to “reform” health care besides attempting to alter the fabric of the US Constitution.

    Perhaps 1- medical liability reform, 2- insurance portability could be implemented and then costs could be contained through judicious use of resources. As stated by many, rationing must occur, does occur, and will continue to occur. It’s up to us to ration care as fairly and intelligently as possible.

    Therein lies the rub. What’s fair and from whose perspective?

  • gzuckier

    Lemme get this straight; it’s unconstitutional for the government to require everybody to choose from a wide spectrum of options provided by a somewhat diverse bunch of companies which only have to meet some minimual standards of usability for their product, or else opt out by paying a $90 fee; but it isn’t unconstituional for the government to enrol everyone in Medicare without exception, subtract the costs from their every paycheck (and divert them to finance unpopular wars), and then provide them with predefined benefits without option for reimbursement should they choose not to take those benefits and shop elsewhere?

    I say this not because I think Medicare is unconstitutional, but quite the opposite. Those who think the mandate is unconstitutional should be required to either explain why Medicare with its far more stringent intrusions on individual liberty is OK in their book, or else confirm that they are equally adamant about repealing Medicare as well, and see how that goes over.

    • Alice

      Because the government is paying. And if people could see this through and look at the same problems and limitations with socialized medicine they would oppose the public option. The media has done a poor job with the facts. Rarely is a country like France discussed…you give a quarter of your check each week to the government for healthcare, then the rest of the taxes are paid after that. You still have co pays, etc. And France like the UK is steering towards conservatism because socialized medicine and government perks eventually cripple commerce and that means less people paying in. Then you suffer the cuts…and cuts hurt people on once again the commerce level and healthcare level. The domino effect.

  • jim jaffe

    I am not a lawyer and not aspire to be. that said, the government imposes a series of rules on most people who are employed, which is very different from requiring people to have health insurance. similarly, everyone with a car or drivers license in many states is required to have auto insurance, but you can avoid that by now owning a car. and you can avoid medicare taxes by not being employed. what’s different about the mandate is (a) that it is imposed on all without any such option and (b) that the payment is from a private company

    • Paul Dorio

      What would be great is a Consumer Reports type review of various healthcare systems.

  • jacomment

    A 3000 page health care law was bound to get into a constitutional mess somewhere down the road. This law was a far way away from being implemented without major changes. But one way that no one seems to take into consideration is that the powers-that-be, our congressmen and the President, HAVE NO HEALTH CARE CONCERNS. They have set themselves up with lifetime care, even after a partial term of office (as those of us in Illinois have learned from Buris), paid for by the taxpayers. Along with their full pensions after 2 years of work. It’s time for the voters to get the powers-that-be in the same boat as their constituents, and maybe then something might happen. No free retiree health care for politicians!

    • jim jaffe

      those of us trying to have a serious conversation are troubled by such broad brush assertions that are largely false. Members of Congress don’t get full pensions (whatever that means) after 2 years of work. nor do they get lifetime health care. in fact those who serve for an extended period until they’re normal retirement age are eligible for health benefits not unlike those offered by large private sector firms. if you have a beef, better to start with the facts

      • Alice

        We know our elected reps have the best healthcare, they have private pensions, can vote themselves raises, and very often are clueless about class struggles. Many have constituents who want everything from them… started out in the thirties as temporary relief…then instead of a gift it became entitlement for necessities, which brought us to the point some people think the government owes them cars and houses. It is unsustainable.

        I think the original poster was trying to relay that our reps have perks….and some voted on a bill they did not read, and some voted hoping for repeal…they just wanted another perk for their own election buckle…it didn’t work out that way exactly.

        • jim jaffe

          well yes, Members of Congress have the same fringe benefits that other Federal employees have, including subsidized health insurance and pension plans. Anyone who craves such benefits can go to work for the IRS or Agriculture Department if jobs are available. And yes, they voted for legislation they didn’t read, just as physicians often prescribe based on studies they didn’t read. And, incidentally, they work more hours for less money and job security than others with similar credentials. If you think demonizing them somehow helps solve our problems, demonize away

          • Alice

            Not demonizing…but I worked for Social Security and NASA, and to my knowledge our reps have the option of a better offering. One rep showed you the building he can walk into with Nave Officers, etc. And said he can get an MRI daily if he wants. His own words shared it is a better plan than most Americans.

            It is just odd they get to vote on things like social security while not paying into it. Their private pension is better…same with teachers, and federal employees. So the healthcare illustration is a fair one…not demonizing.

  • imdoc


    I am talking about real free markets in which consumers (patients) have purchasing power. Cosmetic procedures are the only thing obeying laws of supply and demand.

  • Alice

    I do not have time to read the very liberal Ezra Klein articles referenced. He runs JournoList where conservatives cannot join, conspiracies and Olbermann are King….but he writes for TIME and I read some of his stuff. Doesn’t he just hope this Conservative judge will be overruled by the Supreme Court?

    I listened to High Hewitt tonight….isn’t he a Constitutional attorney? He had an interesting take on why the Republicans will fail…not at changing parts of this bill…but at 2 am I will wait and reread it before posting.

    Raussmusen’s latest poll would disagree with Klein, but hey he’s young…educated in a liberal system…studies show when he grows up he will mature like fine wine and find the truth….and it is not from feeding off the rich Uncle…..I think his name…for now anyways…is Sam.

    Oh and by the way we are not as low on the world healthcare scale as the quotes in this article state…..liberals…..gotta love the way they rewrite history, healthcare, and quote crappy research…the truth gets buried. And tell me once again what other country liberals are going to for their fine healthcare? Oh …um…that’s right….a lot of them are already getting healthcare for free…….if they would stop and really think….take off their, “it’s my right” cap they would see this judge made a great, though limited decision. I love it when judges actually understand the constitution. It is only a few pages long after all…..pretty funny stuff when Jon Stewart knows more than some liberal judges…..until you stop and really think about voters who do not even know what their candidate stands for…they just know it is helpful to their own gravy train….or other aspects I will discuss later.

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