If 'Obamacare' Falls, Will 'Medicare for All' Rise?

After last week's deliberations before the US Supreme Court over Obama's signature health care reform legislation, the Affordable Care Act, speculation is rampant about the political fallout if the nation's highest court knocks down some, or all, of the law.

Conservatives would see a move to throw out the law (which they derisively call 'Obamacare') as a victory, whereas Democrats and those who championed the legislation would consider it an affront to jurisprudence and a defeat of the president's largest domestic policy initiative. Progressives, however -- who only reluctantly accepted the law's passage after their preferred alternatives, either a single-payer system or a 'public option', were ruled out -- may ultimately be the ones who claim victory if the Supreme Court invalidates the 'individual mandate' or the entirety of the Affordable Care Act.

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TalkingPointMemo's Sahil Kaptur reports this morning: Why Overturning 'Obamacare' Could Lead To Single-Payer

If the Supreme Court strikes down "Obamacare," Republicans claim a huge short-term victory, but they may end up big losers in the long run. The future of the nation's health care system would be thrown into disarray, and conservatives may be forced to swallow a more bitter pill.

The prospect of moving toward a more liberal, government-controlled health care system is fraught with political peril, and therefore far from inevitable, but may wind up being the only way to prevent the demise of the unsustainable, existing system from leaving many more millions without access to health care. Without a mechanism like an individual mandate to cover the uninsured and tackle the free-rider problem, health care costs are set to rise at an unsustainable rate and compel potentially drastic action from Congress.

"Conservatives may find that they weren't careful about what they wished for in opposing 'Obamacare,'" Adam Winkler, a constitutional law professor at UCLA School of Law, told TPM. "The economic, social and political pressure for health care reform aren't going to just disappear. There's a reason every major industrialized country has national health care. If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade."

In that scenario, progressives could turn to two alternatives that have proven successful at lowering costs in other countries: A single-payer plan a la Medicare but for everyone, or a two-tier system in which private and public insurers compete. Both concepts are anathema to Republicans, but their constitutionality is not in doubt -- and the GOP has been unable to devise a replacement plan, which could give liberals ammunition for their cause.

There's little doubt that the idea behind the individual mandate -- in which Americans either buy insurance or pay more in taxes -- would be constitutional if rewritten explicitly as a "tax" as opposed to a "penalty" for not buying a product. But the political fallout of a Supreme Court decision to strike it down may well scare lawmakers away from the concept altogether.

"The defenders of federalism will be rewarded with an even bigger federal government," Winkler said. "Wouldn't that be ironic?"

Rose Ann Demoro, executive director of National Nurses United, wrote last week:

Today Medicare remains a more efficient, cost effective, humane system for delivering healthcare, and guaranteeing it to everyone who is eligible, in a far superior manner to the broken dysfunction privatized insurance system that is based on profit and ability to pay, not on patient need.

Sure, the Affordable Care Act does have positive elements, including some restrictions on the abuses that characterize the insurance industry, and the provision that lets young adults up to 26 to remain on their parents' health plan.

But even if Obamacare survives the court challenge - a prospect looking increasingly dim - it would leave millions of Americans out in the cold.

Despite its name the Affordable Care Act has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar. It does little to crack down on insurance companies denial of medical treatment they don't want to pay for. It leaves 27 million Americans with no health coverage, according to a Congressional Budget office estimate in early March.

And for many who are covered, it further tethers them to a callous, insurance system that treats patients as commodities, not as individuals with individual needs.

And Robert Reich, in a much cited piece, said compared to the private insurance model, "Medicare is a great deal." He continued:

Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare's costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?

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