***The “What Then” Debate

Now that there is a reasonable possibility that the Supreme Court will strike down as unconstitutional the individual mandate that represents the glue holding the Affordable Care Act together, we are hearing the first stirrings of debate, on both sides, of the inevitable “What Then” question.

Some Democrats actually think it wouldn’t necessarily be a bad thing. James Carville can see a campaign issue in the most abject policy defeats:

“I think this will be the best thing that has ever happened to the Democratic Party,” Carville said Tuesday on CNN’s “The Situation Room with Wolf Blitzer.”

He added: “You know, what the Democrats are going to say, and it is completely justified, ‘We tried, we did something, go see a 5-4 Supreme Court majority’.”

Carville, who gained fame working on Bill Clinton’s 1992 presidential campaign, predicted health care costs will only increase in the future, in which case Republicans will be to blame for leading the drive to expel a federal program designed to help Americans cover those costs.

“Then the Republican Party will own the healthcare system for the foreseeable future. And I really believe that. That is not spin,” Carville said.

Robert Reich spoke for those progressives who really disliked the design of the ACA, and might be able to turn its destruction into a fresh opportunity to take a different direction:

If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

There’s been less debate so far among Republicans, who seem to think that polls indicating the unpopularity of ObamaCare will give them a breathing space to regroup if it’s cut down by the Court, even though polls also show many features of the ACA are very popular. David Frum offered Republicans a reality check about public opinion, even if the law is upheld:

“Repeal” may excite a Republican primary electorate that doesn’t need to worry about health insurance because it’s overwhelmingly over 65 and happily enjoying its government-mandated and taxpayer-subsidized single-payer Medicare system. But the general-election electorate doesn’t have the benefit of government medicine. It relies on the collapsing system of employer-directed care. It’s frightened, and it wants answers.

Since conservatives cannot go back to what they were proposing just a few years ago–you know, a competitive system of private insurance options complemented by an individual purchasing mandate and federal regulation of coverage denials and rates–they may have problems responding to this scenario.

Sure, Republicans have their highly misleading pet rock proposals to hold down premiums–interstate insurance sales and “tort reform”–and a shriveled booby prize of an approach to extend health insurance to people who are routiney denied coverage–state-run “high-risk pools” that typically offer crappy coverage at astronomical rates. But all the focus on ObamaCare since 2009 has obscured the fact that most people who are not on Medicare pretty much do hate the health care status quo ante, and will expect both parties to propose new reforms.

If nothing else, the “what then” debate will provide a fruitful occupation for the chattering classes during the three months or so when we all await a Supreme Court decision.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.