So you thought health care was fixed. Well, maybe not "fixed," but you assumed that the new law had put us on the path to solving one of America's most pressing problems -- spiraling health care costs amid surging numbers of uninsured citizens.

No, no, no, no.

The recent decision by Judge Henry E. Hudson, of a U.S. district court in Virginia, pumps new life into Republican efforts to kill health care reform by draining the program of a means to pay for it. Hudson argued that forcing anyone to buy something -- in this case, a private insurance policy -- is unconstitutional. (Two other district court judges rejected that interpretation.)
Why is the individual mandate essential? Current law requires hospital emergency rooms to treat all comers. Without the mandate, uninsured people could wait to buy coverage until they're in the ambulance. In 2008, doctors and hospitals delivered $43 billion in "free" care. (Of course, it was not free. Taxpayers and anyone with private coverage picked up those bills.)

Years ago, Massachusetts forbade insurers to discriminate against sick people, but it didn't also insist that everyone obtain coverage. What happened? Premiums jumped. Since it added the mandate in 2006, premiums have fallen 40 percent.

If the mandate goes, so go the parts of the law that stop insurers from rejecting those with pre-existing conditions or canceling policies once the policyholder becomes seriously ill. In an efficient insurance pool, as we've seen in Massachusetts, healthy people must subsidize the sick.

This concept is not foreign to Republicans and has been part of their own past health care proposals. But the new law's inclusion of an individual mandate has suddenly become a big, big problem for them.

Actually, Republicans do not object to expanding government health care as much as they mind paying for it. They did not set aside a single penny for their 2003 Medicare drug benefit, tacking it all onto the national debt. (A giveaway to insurers and drug companies, the Medicare drug benefit is costing about the same as the Democrats' reform of the entire system.) Former U.S. Comptroller General David Walker called it "the most fiscally irresponsible piece of legislation since the 1960s."

And let's drop the fairy tale that the Grand Old Party's deficit cowboys have been replaced by fiscally conservative new blood. In their book, "Young Guns -- a New Generation of Conservative Leaders," Reps. Paul Ryan of Wisconsin, Eric Cantor of Virginia and Kevin McCarthy of California talk piously of fellow Republicans having "lost their way" and pretend they are different.

But when it came time in 2003 to vote on the "most fiscally irresponsible piece of legislation," what did the "young guns" actually do? They voted for it. Ryan said "yea." Cantor said "yea." (McCarthy was not yet elected to Congress.)
This latest legal attack on the health care law doesn't make much sense. The federal government argues that the mandate to buy coverage is indeed constitutional because the fine for not having it would be levied as an income tax.

Meanwhile, it's hard not to laugh at the cries over the "injustice" of forcing people to buy coverage. Working Americans are already forced to buy health coverage -- but for others. They can't choose not to pay the Medicare payroll tax. They can't even make a deal with the government, promising, "I will forgo all future Medicare benefits if I can be freed from the Medicare payroll tax."

If the new health care reforms die, America will find no relief from the economic deadweight of spending twice per capita on health care as other rich countries. It would mean another push down the slope of national decline.

Copyright 2010 The Providence Journal Co.

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