A huge win for health care in America

From the opinion: “The combination of no tax credits and an ineffective coverage requirement could well push a state’s individual insurance market into a death spiral. It is implausible that Congress meant the act to operate in this manner. Congress made the guaranteed issue and community rating requirements applicable in every state in the nation, but those requirements only work when combined with the coverage requirement and tax credits. It thus stands to reason that Congress meant for those provisions to apply in every state as well.”

Yes! The court understood that the law is designed to work via the “three-legged stool” of the individual mandate, subsidies and the guaranteed issue and community rating requirements. All three elements are needed to make the law work, which is why it was obvious to anyone who paid any attention that the lawsuit was nonsense.

The thing is, a lot of people on the right have never grasped this logic, either because all they needed to know was that Obamacare was evil big government incarnate, or because of Upton Sinclair’s principle that it’s difficult to understand something when your salary depends on your not understanding it.

But those who voted with the court’s majority opinion did the basic policy analysis, which gratifies my inner wonk, as well as my outer health reformer.

Obama’s Legacy

Last fall I wrote a long article for Rolling Stone magazine arguing that history will in the end judge President Obama pretty well: “Despite bitter opposition, despite having come close to self-inflicted disaster, Obama has emerged as one of the most consequential and, yes, successful presidents in American history. His health reform is imperfect but still a huge step forward - and it’s working better than anyone expected. Financial reform fell far short of what should have happened, but it’s much more effective than you’d think. Economic management has been half-crippled by Republican obstruction, but has nonetheless been much better than in other advanced countries. And environmental policy is starting to look like it could be a major legacy.” (Read the article here: rol.st/1vTHFTg.)

This was, at the time, very much at odds with the preferred pundit narrative, according to which Mr. Obama was teetering on the edge of a failed presidency, under which his decision to pursue health reform was a big mistake. But suddenly it seems as if conventional wisdom is coming around.