Turning Shit to Gold

Hard to see how legislators could succeed where generations of alchemists failed:

If the Court strikes down the individual mandate, health insurance company lobbyists and executives will swarm Capitol Hill seeking to have the Act amended to remove the requirement that they insure people with preexisting medical conditions. They'll argue that without the mandate they can't afford to cover preexisting conditions.

But the requirement to cover preexisting conditions has proven to be so popular with the public that Congress will be reluctant to scrap it.

This opens the way to a political bargain. Insurers might be let off the hook, for example, only if they support allowing every American, including those with preexisting conditions, to choose Medicare, or something very much like Medicare. In effect, what was known during the debate over the bill as the "public option."

Given the prevailing dialectic that's the lingua franca of our Beltway policy elite, I think it's much more likely we'd end up with a Grand Bargain in the form of Vouchers For All: a bold, honest and sensible approach to managing unsustainable health-care costs, offering coverage for all while getting America's fiscal house in order. Because it's bold, honest and sensible, because it's fiscally responsible, and because it can be sold to low-information voters (i.e., most Americans) as a panacea to their ills. But Medicare For All? Get real.

---Vitelius