The Obama administration’s remake of the U.S. health care system stands on three legs. One, it makes the purchase of insurance compulsory. Two, it doles out new entitlements via expanded Medicaid, subsidies, and certain coverage requirements. And three, it promises to control the growth of medical costs. These three parts differ in their implications and prospects. The first leg may give way altogether; the second is partially already in place; the third provides the rationale for centralized allocation of resources in health care. This summer the Supreme Court is to decide on the constitutionality of the 2010 Patient Protection and Affordable Care Act, which faces various challenges to its thousands of sections. Moreover the centerpiece challenge to the individual insurance mandate may invalidate other provisions as well. In fact the uncertainties extend well beyond the Supreme Court decision and its consequences. Not only the results of the 2012 presidential election but also congressional and state elections may result in changes to the law or to the way it is applied.
