Wouldn't it Be IRONIC: The 2013 Headline reads "Conservatives Win Mandate Battle but Lose Single-Payer War!" [128*10]

WHAT IF THE SUPREME COURT rules against President Obama, in toto? After listening to three days of oral arguments by the Justices and a few words the litigants were able to squeak in edgewise, it was clear to me, and the pundits (who quickly reversed positions) that Obamacare, as we know and love it, was in trouble. Two justices hold its fate in their hands, Chief Justice Roberts and Associate Justice Kennedy.

In this hub, I am going to assume the Conservatives win, and Obamacare is flushed down the toilet where they think it belongs and ask the question, "what happens next?" I will explore one ironic possible outcome ... the ultimate passage of a "single-payer" health plan, the last thing Conservatives would ever want to see. How could this strange scenario come about?

TO BEGIN ANSWERING THAT QUESTION, we need to look at what is currently in operation that will presumably stop once Obamacare is found Unconstitutional. The following, then, are the benefits currently being received and by whom and how many, if I can figure that out:

• Stop insurance companies from limiting the care you need. these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage. [INSURERS WILL BE ABLE TO START DOING THIS AGAIN!]

• Remove insurance company barriers between you and your doctor. These rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral. Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network. [INSURERS WILL BE ABLE TO BETWEEN YOU AND YOUR DOCTORS AGAIN!]

• Reviewing Insurers’ Premium Increases. This provision provides money to the states to strengthen their insurance premium oversight abilities to help prevent unreasonable premium hikes which can put insurance out of reach of many working families and small employers. [INSURANCE COMPANIES CAN RETURN TO UNREASONABLY RAISING YOUR RATES]

• Getting the Most from Your Premium Dollars. This provision requires insurance companies to expend between 80% to 85% of their premiums on direct medical care and efforts to improve the quality of care you receive – and rebate you the difference if they fall short. [INSURANCE COMPANIES CAN RETURN TO PAYING EXORBINANT SALARIES TO TOP EXECUTIVES WHILE SHORTCHANGING YOU ON YOUR HEALTHCARE]

• Keeping Young Adults Covered. Children under 26 will be allowed to stay on their parent’s family policy, or be added to it. [1.5 MILLION YOUNG ADULTS WILL BE REMOVED FROM THE INSURANCE ROLLS] (Guess what, they vote.)

• Providing Affordable Coverage to Americans without Insurance due to Pre-existing Conditions: This provision allows Americans locked out of the insurance market because of a pre-existing condition to begin enrolling in the Pre-existing Condition Insurance Plan (PCIP). This program offers insurance without medical underwriting to people who have been unable to get it because of a preexisting condition. It ends in 2014, when the ban on insurers refusing to cover adults with pre-existing conditions goes into effect. [MILLIONS OF ADULTS WITH PRE-EXISTING CONDITIONS WILL BE WITHOUT INSURANCE AGAIN!] (Guess what, they vote.)

• No Pre-Existing Condition Exclusions for Children Under Age 19. Each year, thousands of children who were either born with or develop a costly medical condition were coverage by insurers. Under this provision, that has stopped and they must now be covered. [HUNDREDS OF THOUSANDS OF PRE-ADULTS WITH PRE-EXISTING CONDITIONS WILL BE WITHOUT INSURANCE AGAIN!] (Guess what, their parents vote.)

• No Arbitrary Rescission of Insurance Coverage. Insurance companies are no longer able to retroactively cancel your policy when you become sick, if you or your employer made an unintentional mistake on your paperwork. [INSURANCE COMPANIES CAN RETURN TO PRACTICE THIS LEGAL YET VERY IMMORAL ACT!] (Guess what, these people can vote.)

• No Lifetime Limits on Coverage. Millions of Americans who suffer from costly medical conditions are no longer in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits set by their insurers and plans. [OVER 100 MILLION AMERICANS WILL HAVE LIFETIME LIMITS PLACED BACK ON THEIR POLICIES!] (Guess what, these people can vote.)

• Restricted Annual Dollar Limits on Coverage. Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for health care during the plan year. Obamacare does away with these limits initially, and then sets them very high after 2014. [ALL SENIORS WILL HAVE TO START PAYING FULL PRICE FOR PRESCRIPTIONS AGAIN!] (Guess what, these people can and will vote.)

• Protecting Your Choice of Doctors. Insurance companies don’t always make it easy to see the provider you choose and often you need a referral. The provisions of the Act bar insurance companies from using doctors of your choice. [INSURANCE COMPANIES WILL ONCE AGAIN GET BETWEEN YOU AND YOUR CHOICE OF DOCTORS!]

• Removing Insurance Company Barriers to Emergency Department Services. Insurance companies sometimes limit your choice of emergency care providers or require a referal for emergency care. That barrier has been removed..[INSURANCE COMPANIES WILL ONCE AGAIN GET BETWEEN YOU AND YOUR CHOICE OF DOCTORS!]

• Payments for Rural Health Care Providers. The law provides increased payment to rural health care providers to help them continue to serve their communities.[THESE INCREASED PAYMENTS WILL STOP CONTINUING THE DECLINE IN AVAILABILITY OF RURAL HEALTH CARE!]

• Improving Care for Seniors after They Leave the Hospital. The Community Care Transitions Program helps high-risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities. [SENIOR WILL LOSE THIS BENEFIT!] (Guess what, seniors can and will vote.)

• Addressing Over-payments to Big Insurance Companies and Strengthening Medicare Advantage. Medicare had paid Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. The result was increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law leveled the playing field by gradually eliminating this discrepancy. [ORIGINAL MEDICARE ENROLLIES WILL CONTINUE TO PAY MORE THAN THEIR FAIR SHARE!]

• Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare. [SENIOR WILL LOSE THIS BENEFIT!] (Guess what, seniors can and will vote.)

• Provides a tax credit for small businesses. The law currently allows for small businesses up to 35% of their contribution to purchasing health insurance for their employees.[SMALL BUSINESSES WILL LOSE THIS TAX BREAK AND SOME WILL CANCEL THEIR EMPLOYEE INSURANCE PLANS!] (Guess what, these people can vote.)

• The law will provide a 10% Medicare bonus payment for primary care physicians and general surgeons.• [PRIMARY CARE PHYSICIANS AND SURGEONS WILL LOSE THIS BONUS!]

IT SHOULD BE APPARENT THAT tens of millions of American citizens lives will be hurt, hundreds of thousands significantly, if the Supreme Court strikes down Obamacare; there are many very important provisions that are now effective that will disappear! You can bet the Democrats will remind each one of them of what they are going to lose every day from the moment the Supreme Court announces its historic decision, to the first Tuesday in November 2012. What will this mean to Conservatives?

One possible scenario is these tens of millions of people will now be motivated to vote, and they won't be voting for the party that just made their lives more miserable and put them back into the vulnerable position they once were in. The possibility of a Democratic sweep in 2012 is a very real one, in my opinion. It is certainly not out of the realm of possibility that Conservatives will lose control of the House and Democrats can get back a veto-proof majority in the Senate. Don't you agree?

IT GOES WITHOUT SAYING that the Democrats will take their sweep back into power as a mandate to reestablish Obamacare. But, what to do? The core of the Affordable Care Act, the individual mandate, was declared unconstitutional by the Supreme Court in June 2012 (in our hypothetical, of course). There isn't much left to do but enact the Conservative's worst nightmare, a Medicare-style single-payer plan.

What happens when the individual mandate is made unconstitutional is one way of making sure there are enough healthy young people in the insurance pools to make it profitable for insurance companies to offer insurance at an affordable price. The individual mandate was one way to efficiently accomplish this goal, but, that option is no longer available. That leaves the "single-payer" system as the only real viable alternative, one many Democrats prefer anyway.

What is a "single-payer" system anyway? In America, one possible variation is that a single payer, the federal government, would pay the health insurance premiums to the health insurance companies for a predetermined set of minimum essential services. I would suspect what might happen is the Medicare program will be expanded and the Medicare tax increased to pay for it; it seems the simplest solution because Medicare works, and most that use it, like it.

That method gets around the Constitutional issue because Medicare has already been settled; this program just extends coverage to the rest of America. I would hope there would not be a whole lot of debate about this within the Democratic party, but knowing them, they will probably squabble so much with internal bickering that the entire effort will be put in jeopardy once again.

But, there you have it; how a tactical victory has been turned into a strategic defeat. What do you think?

THE LATEST CNN/ORC NATIONAL SURVEY once again, as it has for three years, shows that a majority of Americans want some sort of Obamacare-type health coverage. In the poll, 35% DO NOT support Obamacare, 16% think Obamacare doesn't go far enough and needs to be stronger, and 46% DO support Obamacare.

As expected, Conservatives once again falsely parade around the 46% result rather than the more correct 35% Against or 60% For national healthcare coverage; but then, that is what politicians do, isn't it, it just happens to be Conservatives this time.