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What if the health care law is struck down?

We'd go back to a deeply flawed system that leaves millions uninsured and facing ruinous health care costs.

By MSN Money Partner Mar 27, 2012 1:08PM

This post comes from Rick Newman at partner site U.S. News & World Report. on MSN MoneyIf the Supreme Court strikes down the individual mandate in President Barack Obama's health care law, it could be the loose thread that unravels the whole ball of string.


Image: Pills (© Corbis)Since the mandate is meant to expand the pool of people covered by health insurance, it makes other parts of the law possible, such as subsidies for people who can't afford insurance and a ban on denying coverage to people with pre-existing conditions. Without the mandate, those provisions might be unsustainable and the whole law could effectively become moot.


If that happens, Republicans would gladly declare victory. But we'd revert to a health care system that was deeply flawed to start with and is now arguably in worse shape than when the Patient Protection and Affordable Care Act became law in 2010.


Republicans have railed against the individual mandate on the grounds that it infringes upon Americans' freedom and forces people to do something -- pay for health insurance -- that should be a matter of individual choice, not a government requirement. The past week's Supreme Court deliberations focused narrowly on whether Congress has the constitutional authority to require such a thing.


But lost in the lofty rhetoric is the scale of the original problem, which finally affected so many Americans that Obama was able to overcome decades of opposition and pass the most sweeping changes in the health care system since Medicare and Medicaid were created in 1965.

Post continues below.

As a reminder, here are a few of the basic problems with the U.S. health care system that Obamacare was meant to address:


One-sixth of the population lacks health insurance. In 2008, 45 million Americans had no health care coverage. Two years later (the most recent data available) that number had risen to 50 million, largely because insurance is typically tied to employment and joblessness soared during the recent recession.


Without insurance, health care costs can be ruinous. One study by Harvard researchers found that 62% of all personal bankruptcy filings were related to medical costs that overwhelm a family's budget. The numbers are probably worse now, since that study was done in 2007, before the recession put an additional 8 million Americans out of work.


People die because they lack insurance. A 2009 study found that a lack of insurance causes or contributes to the deaths of 45,000 Americans each year. Some people die because they put off getting treatment for conditions that worsen to the point of being fatal. People without insurance also tend to get lower quality care than those with coverage.


The high cost of health care distorts the labor market. We all know people who stay at a job they'd otherwise leave because they're afraid to give up health care benefits. That prevents some people from taking entrepreneurial risks or moving to jobs that might enhance their careers. Bearing the cost of employee health care also puts some U.S. companies at a disadvantage against competitors in Europe and Japan, where the government provides most coverage. Many U.S. companies offset the rising cost of health care benefits by limiting pay.


American health care is a bad bargain. Americans spend nearly twice as much per capita on health care as developed countries do on average, yet the United States ranks below average on many key quality indicators, including life expectancy and infant mortality.


Most trends are going in the wrong direction. The cost of health care is rising far faster than incomes, fewer families can afford coverage, and skyrocketing health care costs are the biggest threat to the federal government's solvency.


The Affordable Care Act, which mostly goes into effect in 2014, has flaws and probably wouldn't solve all these problems under any circumstances. It would extend coverage to perhaps 30 million additional Americans, for instance, but still leave some people uncovered. The ACA doesn't directly address the cost problem either, and it could take decades for the overall efficiency of the U.S. health care system to improve.


But it does address some important problems, and most Republicans who call for the repeal of the ACA aren't proposing a better alternative. For the most part, they simply seem to be advocating a return to the status quo ante, as if we had an effective health care system before Obama came along and ruined everything.


Republican presidential front-runner Mitt Romney at least has some experience with health reform, as Massachusetts passed a statewide program similar to the ACA in 2006, when Romney was governor. Romney's argument now is that health reform should happen at the state level, not the federal level.


But only a few states tried some sort of health reform before the ACA was passed, and the 26 Republican-led states that are backing the Supreme Court challenge seem to want to obstruct the whole idea. So at best, a few states might find a way to improve their health care systems in the absence of health care reform, with a patchwork of rules and standards that vary by state.


Other Republican plans for lowering health care costs and expanding coverage amount to a smattering of warmed-over proposals, such as caps on medical liability and expanded health savings accounts that, theoretically, would lower costs by creating a better free market dynamic in the market for health care. These ideas may have merit, but they've been around for years and never earned enough support to pass Congress.


Besides, pushing any Republican-backed health reform plan through Congress in the future would be at least as contentious as the Obama plan was when it barely passed in 2010. If the Supreme Court strikes down Obama's law, the fight over health care may just be getting started.


More on U.S. News & World Report and MSN Money:

Mar 27, 2012 3:42PM
This isn't a democrat or republican thing Rick. It's the Constitution of the United States we are dealing with.  You accused the US Supreme Court if they repealed this healthcare that they were being narrow minded. You are an incompetent unworthy of your own article. You are an embarrassment to legitimate authors across the land. This is the most slanted piece of garbage ever. I can only hope US News fires you for writing such crap. Stop trying to incite a riot. Stop trying to become somebody you will never be...a productive optimistic contributing member of society. 
Mar 27, 2012 4:14PM
Have we all forgotten the innumerable back door deals and behind closed door meetings it took to get this through that decrepit Congress? Topped off by Pelosi's idiotic comment of "I guess we'll have to pass it to find out what's in it." What a red flag. This law was written by Unions and the Insurance companies it's supposed to fix. Do you REALLY think they changed the system to their detriment? If you believe that, I've got some great water front property to sell you 100 mi west of California ...
Mar 28, 2012 11:16AM

In a television  interview recently President Obama was asked if he and his family  will be signing up for the New Health Care Program. Here is his answer "       "


Thank you for listening.

Mar 27, 2012 5:32PM
to the "author" of this hit piece: You are missing the whole point of the argument.  The government does NOT have the right to force anyone to buy anything. This law used the healthcare problem in this country to wedge open the door to government mandated "everything".  It was not intended to fix health care.  The liberal/progressive/socialists were hoping we would not notice the clause.  Well, we did, and we are also noticing the flood of executive orders and new EPA garbage coming from D.C. You can kiss your precious healthcare bill and your community organizer president good bye in November. ABO 2012
Mar 28, 2012 12:38PM
If the system and law is unconstitutional, then start over. Don't retain a bad program just to save bits and pieces.
Mar 27, 2012 7:05PM
It's really simple, a vote in favor of the individual mandate is a vote AGAINST liberty.  If the individual mandate is upheld, there is no end to the power of the federal government.  They could use the commerce clause as justification for ANYTHING - mandating that citizens get their identity tattooed as a bar-code on their arm, mandating that all citizens purchase GM vehicles, mandating that all citizens eat certain foods or live in certain areas based on their medical conditions, mandating that all citizens attend sensitivity training or utilize certain banks, etc...  This slippery slope has become a steep cliff - will the SCOTUS force us all to jump??  Oh, and it seems inevitable that we'll get a 5-4 decision either way, which is completely RIDICULOUS!!  This case should be decided in a matter of minutes and all 9 justices should be chastising Obama and the Congress for daring to pass such an egregious and unconstitutional assault on individual liberty.
Mar 27, 2012 5:27PM

You state, "But lost in the lofty rhetoric will be the scale of the original problem, which finally affected so many Americans that Obama was able to overcome decades of opposition and pass the most sweeping changes in the health care system since Medicare and Medicaid were created in 1965.".  Democrats controlled the Senate, House, and Executive Office at the time.  Obama could have passed anything he wanted...which is evident based on Pelosi's comment about voting on it now and reading it later.    True, health care is a very important issue which affects millions of Americans and requires a comprehensive solution.  The problem is that Obama has created incredible tension between those who pay most of the taxes in this country and those who receive these funds by using the rhetoric of pay your "fair share".  That has made this discussion more about redistribution of wealth and individual rights than about health care, which is a shame. 

Mar 28, 2012 6:51AM



It is a slippery slope when Congress can under the guise of "interstate commerce" decide that you must buy a product that cannot be sold now across state lines.


If Congress can mandate that you purchase something against your will, then they can force you to buy or contribute to anything.  What next a religious group? 


Congress is in effect forcing you to engage in commerce. 


Healthcare costs are the highest in the world in the US because government sets prices through Medicare.  Plain and simple.  Prior to medicare, healthcare accounted for 6% of GDP, today that number exceeds 17%.   Government is the problem, not the solution.  Only the free market can keep costs down.  We have done away with that.


Healthcare services will always be rationed.   They are a limited resource.  Be it via Price, Insurance companies, Healthcare personnel or government panels, this needs to be done. 


If we were to have a single payor system (not a bad thing, provided the taxes collected are enough to cover costs), and EVERYONE were TAXED enough to cover the costs (see Medicare and Medicaid), it could work.  But in the end it is socialist, as those that do not need or want the product are forced to pay for it so others benefit.


Once again, if the product is so good and compelling, let participation be voluntary.  Otherwise stop limiting FREEDOM and LIBERTY.

Mar 27, 2012 6:16PM
Well, I am extremely happy to see all 6 comments so far as being against the article.  That means that people really are paying attention to what this is all about.  If this was only about Healthcare, why did they bury so much other stuff deep within the law.  No wonder it approaches 3000 pages. Nobody on the right that I am aware of, and I'm a Republican, is saying the Healthcare system doesn't need fixing.  It does and we all know it.  And plenty of ideas from the right have been summarily dismissed by the left and the ones that actually made it to the Senate sit there because Harry Reid won't bring them up for a vote.  What a crock of you know what.  Major tort reform, buying across State lines would be two giant steps in the right direction but won't even be considered by the left. A comment further down that says this is a thinly disguised ploy if you will, a first step to require anything it wants.

Brutus: "This case should be decided in a matter of minutes and all 9 justices should be chastising Obama and the Congress for daring to pass such an egregious and unconstitutional assault on individual liberty."


Now we know the reason why we need a Republican in office this November.   The President who will be in office will nominate a couple of more SCOTUS Justices.  


What would life be like if we had a couple of more Sotomayors or Kagens on the court?    Bad for people that want to live free and good for people that want to live on a Gov't dole. 

Mar 27, 2012 3:51PM
What happens if it's struck down? The 55% who favor its repeal, who are also paying the way for those who want a free ride, will rejoice. That's what will happen.

Keep the few very popular and affordable portions of the bill, trash the rest.

Mar 28, 2012 3:45PM

We already require people to purchase car insurance, why is this any different?


Ans: 1. Driving is voluntary.  2. Auto insurance is regulated by the states, not the federal government.  States have the right under the 10th amendment to regulate insurance.  Some states don't require auto insurance at all.  3. The government can't create commerce where none existed, force you to participate and then regulate it.  4. The Constitution doesn't give this power to the federal government.  The federal government is constrained by the constitution to limited powers ie defense, taxation, control of our boarders (how's that one working?).

Mar 28, 2012 9:26AM
Mar 27, 2012 5:29PM
What a ridiculous pile of crap Rick Newman has written.  Maybe you should do some real research and reporting.  Use factual data instead of repeating garbage spewed by "big government" zealots.
Mar 28, 2012 8:20AM
You can blame it all on the Democrats for jamming this piece of crap legislation down the American people's throat.  The did not want to work with anybody to get it right, they just wanted their claws latched into healthcare so they could feed their need for more control.  Let me let you in on a little secret.  I does not matter how much insurance you have, one day you, me and everyone else dies.  You can point your finger anywhere you want to, you are still going to die.  Medicine just prolongs it.  Now as far as costs, you now why it costs so much for medical care?  It is because we have too many lawyers that just want to sue, sue, sue anybody and everybody.  Congress does not want to address this issue because they are mostly lawyers.  Any time you get the federal government involved in a social program it gets messed up. 
Mar 27, 2012 6:27PM
Rick Newman is obviously a Democrat. First of all 50 million Americans are uninsured. most of them are young people who can afford it, but opt not to. Those who can't afford it go to the emergency room. According to my son, an MD, 25% of his cost is government and insurance companies paperwork and, in some cases, medicare fines. His malpractice insurance is also increased by lawyers suing on everything. These are the things that need to be fixed. The Republicans can't fix the problem without first getting rid of Obomacare. bad Bob 
Mar 28, 2012 3:52PM
The author is obviously politically biased. If you have to pass a law and or legislative bill to see what is in it, it is a bad bill regardless of which political party you affiliate yourself with. If the Supreme Court strikes down the entire bill, it is a victory for ALL AMERICANS...not just the Republicans.
Mar 28, 2012 4:39AM
Ideally. the Supreme court would make a decision based solely on the constitution/law and party lines, political views wouldn't get wrapped up in this thing. All you hear is liberal/conservative/party lines/etc. etc. Makes you wonder if justice is truly blind?? Today, the states will argue about the financial aspects of their end of Medicaid and affordability. It seems as though most people can't grasp the scenario of the US going broke. We're spending money as if we're a bottomless pit and what do you think will happen when the Fed gets out of the picture and we go back to our market system. We'll see inflation like we've never seen it before. Interest rates will soar and we'll be in worse shape than this "Great recession". In my mind, the 1982 recession was just as bad as this one if not worse. We've had trillion + deficits every year BO has been in office----no end in sight. The house has passed 100's of bills just sitting on Reid's desk not going anywhere. The HCL will just hasten our demise. It won't save us a dime----just escalate an already bad situation.   
Mar 28, 2012 8:45AM
Look like the person who wrote this is scared to put there name on it. This law is a power grab and that is all it is. 
Mar 27, 2012 10:34PM
I think we need a law that says no one is allowed to eat junk food anymore or they will be fined.
And they all have to purchase organic food, or be fined. I also think that everyone who smokes should have to quit by 2014, or be fined. Oh and they have to purchase stop smoking medications, or be fined. I think we need a law that says we all have to eat right, workout and lead healthy lives. No alcohol, no smoking, no drugs, no junk food, no sodas. And while we are at it, let's get the government to regulate when we have sex and and who we have sex with. I think our government needs to control every aspect of our lives. BECAUSE WE OBVIOUSLY DON'T KNOW HOW TO...and yes, I am being sarcastic. And as far and burying things in the healthcare bill. What's new. They always hide some piece of crap legislation in ever damn bill they pass.

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