I personally hope the Supreme Court strikes down the individual mandate, and I'm somewhat ambivalent on the severing from the larger bill. The Republicans might view that outcome as a victory, but it actually would be a calamity for their party.
Quite frankly, the health care act is about as conservative of a health care solution as could be crafted, while still being possible. It is "free market" health care with some additional regulations attached. Effectively it is transferring the cost of health care onto the working class.
Taking the individual mandate out of the bill will result in health insurance companies going bankrupt. Killing the bill altogether will cause the health care system to unravel, as government funding will collapse with it. The House Republicans would need to scramble to pass legislation full of government subsidies to providers, insurers and patients.
The sane solution to health care is as easy as pie, but would alienate Republicans from their base on ideology. This terrible idea we have enacted is the Republican alternative to the obvious solution.
Obvious Solution:
For people under 65, the government sells Medicare for an income based premium. This coverage would be available to anyone.
This idea doesn't require mandates or burdensome regulation. It can be made deficit neutral or deficit reducing based on premium pricing. It would also offset the Medicare overruns, thus saving Medicare as is.
Imagine Medicare with millions of young healthy people pouring money into the Medicare fund. Right now the Medicare pool is full of high risk individuals. I don't mean to offend anyone, but the fact is that old people get sick more often than young people.
This is why covering children through CHIP and other programs received bipartisan support. The truth is that children don't incur medical costs at frequent enough rates to make such a program expensive.
This isn't universal health care either, but it is single payer. At the heart of this ideology it is anti-free market. Medicare becomes a massive buyer (which it already is), and all health care providers must accept the market demands of the Medicare systems.
If the Supreme court strikes down the concept of private health insurance exchanges with a mandate, the Supreme court is basically damning the very notion of a private health care market.
Nothing could be more conservative than matching buyers and sellers, and relying on market forces to drive down prices. This is the basis of the conservative argument against government intervention.
That is what Obama gave the Republicans to vote on. He gave them a giant bill, which tells everyone to go buy insurance in a free market. In those exchanges there are traditional HMOs as well as health savings accounts. The range of products addresses different consumer needs. Someone can buy a barebones policy or a policy filled with additional coverage options.
Right now, the health care system is heading towards crisis. The rising costs associated with health care are causing fewer employers to offer coverage through an insurance pool. As those people leave these pools, the math makes those pools riskier, which in turn raises the price of premiums.
So one of two things need to happen.
1. Force People back into Private Pools
2. Create a large Public Pool
If you get rid of the mandate, yet keep the regulations, insurance companies will be adding significant risk to pools without anything to offset that cost.
If you get rid of the bill and the mandate, then you point the health care system back towards collapse. In many ways you actually accelerate this rate, by taking the government funding out of states and industry.
You kill option 1, which leaves you with only option 2.
I don't believe the Affordable Care Act will do what it was meant to anyway. In five or six years, people will be pissed as the health care exchanges fail to offer competitively priced products. They will demand congress fix the exchanges to include some kind of public pricing.
Ultimately we will end up with a Public insurance pool similar to Medicare. It is really just a question of when we stop pretending that our current system is rational. By attempting to restrict the commerce powers of congress, the Republicans are just accelerating that reality.