What If Healthcare Reform is Struck Down?

| Mon Jan. 31, 2011 8:00 PM EST

A federal district court judge declared the individual mandate provision of the healthcare reform law unconstitutional today. He also ruled that because Democrats forgot to include a severability clause,1 the entire law is invalid. Ezra Klein thinks that conservatives might come to regret it if the Supreme Court decides he's right:

I think it's vanishingly unlikely that the Supreme Court will side with Judge Vinson and strike down the whole of the law. But in the event that it did somehow undermine the whole of the law and restore the status quo ex ante, Democrats would start organizing around a solution based off of Medicare, Medicaid, and the budget reconciliation process — as that would sidestep both legal attacks and the supermajority requirement.

The resulting policy isn't too hard to imagine. Think something like opening Medicare to all Americans over age 45, raising Medicaid up to 300 percent of the poverty line, opening S-CHIP to all children, and paying for the necessary subsidies and spending with a surtax on the wealthy.

In the long run, I'm sure Ezra is right. But we all remember what Keynes said about the long run, right? And the short run, unfortunately, doesn't look very promising. Democrats aren't likely to control the House anytime soon, and even if they do, they won't have effective liberal control. Ditto for the Senate, where Democrats are defending a lot of swing seats in 2012. And in 2016, it's pretty likely that a Republican will win the presidency. In other words, if PPACA is struck down, the soonest that some kind of single-payerish semi-universal healthcare scheme could pass is probably around 2024.

That's just a guess. Who knows what will happen between now and 2024? But Republicans and conservative Democrats don't seem likely to support anything further to the left of PPACA anytime soon, and they're probably going to control things for the next 14 years at least. So be careful what you wish for.

1Do Democrats need to take a remedial legislation class? They also screwed up the food safety act last year by forgetting to append it to a House bill, as required by the Constitution. What's going on?