Commentary on the ACA ruling by the Supreme Court will dominate the new and old medias for some time to come. What doesn’t change is that the law is awful. Like so many laws that attempt to bring further complexity to a broad and complex problem there are likely to be severe costs and problems. Some of the problems it proposes to solve will be made much worse.
Government has a strong tendency to provide benefits without paying for them. But the costs do not disappear. In this case these costs will appear in the form of higher premiums for those who do buy insurance, poorer service as fewer doctors lead to longer waits often for critical problems, and lower quality as innovation suffers.
The objectives of health care reform have been access and cost. While this law addresses many concerns over access, it comes at a very steep cost, and ultimately this cost will also affect access.
There are clear beneficiares as insurance coverage is expanded. But be clear that coverage is not access. If we increase the demand (expand coverage) but restrict supply (control costs), the newly covered will have better access to care that will become increasingly less available.
While the mandate survived, and in theory would keep premiums under control, in practice it will not happen under this law. The penalty for not complying is so much lower than the actual costs of complying that the base of coverage will not expand nearly enough. Yet those who wait until coverage is needed to purchase insurance will be guaranteed coverage.
Furthermore there are so many groups that will be exempted, and so many additional coverages that will be required that the only source to recoup this cost will be the poor schmucks who are left to actually buy insurance. Their costs will soar. As their costs go up more and more will be driven out of the insurance market, and the problem will spiral.
The way to drive costs down is to free the market forces and individualize insurance care, removing it as an employee benefit. Those who can not afford insurance should get a voucher from the government to buy insurance. This would be expensive but ultimately less expensive and more honest than this terrible law.
This law combines the worse features of a centralized system with the worst features of an individualized system. It is ultimately worse than no solution.