To hear Republicans talk these days, the individual insurance mandate contained within the Affordable Care Act is an act of socialist tyranny so horrific that just thinking about it is almost enough to make blood pour from your ears, which is bad, because some government bureaucrat might say you can't get care for bleeding ears. To take one of many examples, Ron Johnson, the novice politician who defeated Russ Feingold to win a Senate seat from Wisconsin, called, the ACA "the greatest assault on our freedom in my lifetime." This, about an idea that originated with Republicans who wanted to make sure the American health-care system stayed as private as possible.
As Ezra Klein reminds us, that's kind of the whole point of the individual mandate. In a single-payer system where the government is providing insurance to everyone, you don't have to insist that everyone get coverage, because everyone is covered automatically. It's only in a private system that you need to push people to get coverage in order to get everyone into the system. And if conservatives convince the Supreme Court to rule that the unpopular individual mandate is unconstitutional, but the popular provision outlawing exclusions for pre-existing conditions remains, the private-insurance market would implode very quickly. Everyone would wait to get insurance until they're hit with a major illness or accident, meaning the insurance companies would be paying huge claims while getting much less in premiums than they are now. As a result, they would either raise premiums astronomically, or just go out of business.
You can argue that the result of the ensuing chaos would be an irresistible push for the government to step in and just give everyone insurance already, and bammo, you've got the single-payer system liberals have long dreamed of. Maybe. Or maybe, Democrats worried about the potential for enormous human suffering until we get that single-payer plan would join with Republicans eager to restore the status quo ante to repeal the pre-existing condition ban. And then it would be almost like the ACA never happened.
I think the latter is more likely.
-- Paul Waldman