Erin Jenne reminds us that the ACA is still a compromise, not a pure liberal victory:
As anyone who has followed this debate well knows, so-called Obamacare is in fact based on a conservative plan developed in the 1990s partly by the Heritage Foundation in response to skyrocketing health care costs; it was intended to preempt Democratic efforts to develop a universal health care plan that Republicans feared would have a bigger role for the federal government….
Despite certain very helpful provisions in the ACA to help individual policy-holders (ensuring coverage of one’s children up to the age of 26, no denial of coverage for preexisting conditions), the law basically establishes a market for purchasing private insurance, which (apart from the individual mandate–also featured the original Heritage plan) is fully consistent with conservative principles and as far from a socialized health care system as can be imagined.
Meanwhile, from the moderate right, Richard Posner agrees with the legal consensus that the Court should have upheld the ACA on both tax power and commerce power grounds, but still thinks it’s opening a Pandora’s box of government spending:
[T]he law will increase health care costs, and hence the federal deficit, which is already staggering…. There is no way the nation can add 30 million people to the private or public health insurance rolls without experiencing higher health costs. The reason is that insured people demand and receive more health care than the uninsured. That is explicit in Professor Dellinger’s reference to health costs that are “unaffordable” by the uninsured. The care they will now get may improve their health. They may live longer. But the longer people live, the more medical care they need.
I think the best one can say for the law is that it has drawn attention to the manifold problems of our health care system. As a result, or partial result, of the law, some modest improvements, such as recommendations against excessive screening for rare medical problems, are in the works, although they will be resisted by most doctors, especially specialists, who are most doctors nowadays. But I think any cost savings that ensue will be swamped by the 30 million new eager health care consumers.
(Also, Dave Weigel reports that concerns that Republicans would use the Roberts decision as an opportunity to label the ACA a massive tax increase are inflated — they were already doing that anyway.)