I was all set to write a big post on the Supreme Court’s Obamacare decision when it came out last week, but its only in the last few days that I’ve gotten a handle on why Roberts voted the way he did. As David Frum suggested, it appears the dealkiller for Roberts was the four other conservatives wishing to throw out the entire law. That would have created, in a legal sense, a trainwreck involving nuclear waste, forest fires and school buses, so not good.
For one thing, Medicare adjusted its reimbursement schedule two years ago based on the law. Would throwing out the entire law mean all of those payments were illegal and require charging back hospitals and doctors for wrongly paid invoices? The Obamacare law also, for who knows what reason, dramatically reformed the student loan program (the Dept of Education now makes direct “single payer” loans instead simply guaranteeing private loans). Does that make the billions in loans already made ultra vires acts requiring immediate repayment? In a dozen different ways (oh, sorry Indian Health Services, you no longer exist since you were reauthorized in the Obamacare law) it would have created an infinite feedback loop of litigation. I think Roberts voted with the liberals based on the age-old legal principle that un-ringing a bell is damn hard if you don’t have a time machine.
Its all for naught though, Obamacare is a terrible plan that is not long for this world. Seeing as the insurance sector is the only industry Congress has specifically exempted from federal anti-trust laws, dropping half a trillion in “premium assistance credits” into insurance exchanges is a really bad idea. The tax subsidies are uncapped, so competitor collusion to jack up premiums (remember, there ain’t no antitrust law in Deadwood, c********r)– actions than in any other industry would lead to federal indictment– only mean bigger corporate welfare checks courtesy of US taxpayers. Its kind of bizarre that Obamacare commencement was delayed for 4 years after its 2010 signing, (LBJ started enrolling seniors into Medicare the very month it was enacted– he personally signed up Harry and Bess Truman AT the bill signing). Seeing as crashing before takeoff is usually less painful than crashing after takeoff, its a pity Obamcaare was upheld by the Court (it could have severed the unconstitutional part and kept the rest). The sooner we junk it and start over the better.
I’ve written before what I think the optimal way is to provide healthcare ((MMT – JG) + Medicare = MMT) but it seems to me the best way to move the ball forward is for congressional Democrats to hijack the Ryan-Wyden Medicare reform plan (which Romney endorsed, if predorsed were a word, he did that too).
So next winter, offer President Romney (let’s face it, the Yellowstone supervolcano erupting is more appealing than a second term of Obama) a bill that repeals Obamacare’s exchanges and mandate and then auto-enrolls everyone into the Ryan-Wyden Medicare Advantage program. Once everyone’s on the bus, there’s plenty of time to improve Medicare benefits.
1. The individual mandate is very unpopular, Medicare is very popular. There’s a rather large political arbitrage play here.
2. It puts House Republicans (Paul Ryan, in particular) in the curious position of explaining why they won’t replace the hated Obamacare with the beloved Medicare (hard to make the case that Medicare is good for 65 year olds but bad for 64 year olds).
3. Romney would probably go for it. Obamacare’s resemblance to Mass.’s Romneycare is both intentional and politically awkward. It will only get more awkward if its still around to commence in 2014. This is a way (perhaps the only way) for Romney to cut the Gordian knot. After all, “expanding Medicare at the expense of private insurers” is “consistent with the Reagan philosophy of providing coverage where possible at the lowest possible cost. (I suppose Romney could call this Reagancare, but I’d stand pat with Medicare).