If Obamacare falls

The coming U.S. Supreme Court decision on Obamacare will be a landmark no matter what the court decides. The ruling will prompt millions of Americans to examine their health care coverage and ask: How does this decision affect my family’s doctor visits, preventive screenings, hospital stays?

One conclusion is assured: Whether the high court tosses out the entire mammoth law, parts of it, or none of it — health care reform is Americas unfinished business.

One major reason: The 2010 overhaul spends a staggering $1.7 trillion over a decade but does little to tame rocketing health care costs. As those costs gobble more of the federal budget — and the American pocketbook — the pressure grows to find more efficient, less costly ways to deliver quality health care.

The problems Obamacare confronted are pernicious: Millions of Americans are uninsured. Millions cant get insurance because of pre-existing medical conditions. Millions can’t afford insurance.

Obamas solution: A sweeping mandate that all Americans buy health insurance and a massive expansion of Medicaid for low-income Americans.

Both pillars of Obamacare could be toppled by the U.S. Supreme Court.

The Supreme Court decision is not the only threat, however. In five months, Americans go to the polls. Republican candidates — including presidential contender Mitt Romney — are campaigning around the country on repeal and replace, a vow to unwind the health care law if elected. Republicans in the House are pushing several bills to reverse pieces of the massive law. Even if the court rules the entire law constitutional, there still will be an effort starting in January 2013 if not to roll back every one of its provisions, then to gut its funding every step of the way.

A recent New York Times/CBS poll says 68 percent of Americans believe the Supreme Court should strike down all or part of the health care law. Those arent the statistics of a law built to last.

People don’t trust this expansion. And they shouldn’t. Watch what is happening in Massachusetts, where then-Gov. Romney signed a sweeping Obamacare-like mandate in 2006, vastly expanding coverage … before state leaders considered how to trim costs. That’s like enjoying the fancy lobster dinner with the pricey Bordeaux and then checking to see if you have any cash in your wallet.

Result: Massachusetts lawmakers are scrambling to curb health care costs. One spectacularly boneheaded proposal: Bay State lawmakers would set health care spending caps, enforced by a newly created regulatory body empowered to force providers to renegotiate contracts.

If Obamacare falls — by court verdict or congressional fiat — that will not be a disaster. Millions of Americans won’t notice any changes to their insurance.

Most of Obamacare’s policies don’t kick in until 2014. There’s plenty of time — and many good ideas — to reform health care without breaking the bank.

A court dismantling of Obamacare sets the stage for lawmakers, Democratic and Republican, to forge a bipartisan alternative. Congress wouldn’t start from scratch. There are plenty of strong ideas for market-oriented reforms to control costs and provide quality care. Some are as simple as freeing health insurance companies to sell across state lines.

Obamacare’s central mandate also could be replaced with a better incentive for people to buy coverage. A smart suggestion from Princeton University public affairs professor Paul Starr: Offer everyone private insurance that covers pre-existing conditions. Those who opt out must wait five years before being eligible to buy coverage. In the interim, these people could still buy insurance, but no insurer would be required to cover a pre-existing condition.

There would be a very strong incentive to be insured, Starr tells us. You could opt out, wouldn’t pay any fine or penalty, but you wouldn’t get the full benefit of these protections. And if you got sick, you’d be liable, he said.

If Obamacare falls, everyone — citizens, insurance industry officials, providers — will demand a Plan B. That’s a prime opportunity for politicians to solve some of the pernicious problems we outlined above. A warning: We expect people will pay closer attention to cost projections than they did in 2010.

Americans will support a careful expansion of health care, without hidden costs, without budget gimmicks, without running up the tab.

Americans are hungry for a credible alternative to Obamacare, one that carries much less risk for future taxpayers and does not give government control over the delivery of medical care, write James Capretta and Robert Moffit in the journal National Affairs. Now is the time to offer it to them.

We couldn’t agree more. The next health care debate isn’t waiting for the Supreme Court. It has already started because the last one never ended.