Focus now should shift back to where this began – reforming our health-care system

Pundits, politicians and legal scholars are having a field day dissecting and examining the Supreme Court’s ruling on the Patient Protection and Affordable Care Act – aka Obamacare. And rightly so, there are any number of fascinating questions as to how Chief Justice John Roberts came to his decision, why and what it all means for the Constitution and the court down the road.

Missing from much of that, however, is that Roberts effectively worked with President Obama to eliminate the status quo as an option. In all likelihood the United States is now committed to health-care reform. The only question is how well it will be done. And that should be the new focus of the discussion.

The president’s Republican opponents remain keyed in on repealing Obamacare outright. But while that is mathematically possible, it would require them to run the table in the November election. The GOP would need to keep control of the House, win the presidential race and secure a healthy majority in the Senate – perhaps a filibuster-proof, 60-vote supermajority. Anything short of that unlikely trifecta keeps Obamacare in place.

As a generic issue, Obamacare is broadly unpopular, but it is not the most important issue for most people. The economy is. It is not at all clear that repealing the Affordable Care Act is a strong motivation or even a serious concern of swing voters. Roberts’ ruling has inflamed the Republican base, but those voters were not in doubt before Thursday.

Moreover, as president, Romney could not by himself kill Obamacare. He could unilaterally block key parts of the law from taking effect, although, being Romney, it is not clear that he would.

For while Obamacare may be hated in the abstract, specific questions about key parts of the Affordable Care Act elicit a different response. Provisions preventing insurance companies from denying coverage to those with pre-existing conditions or allowing people to stay on their parents’ policies until age 26 are quite popular. So, too, are shrinking the Medicare “doughnut hole” for prescription drugs, mandating free preventive care such as mammograms for women and wellness visits for seniors, and prohibiting insurance companies from limiting lifetime benefits.

What backers are counting on – and what opponents fear – is that as those details become more widely understood, support for Obamacare will grow. And it might, to the point where Romney, if elected in a tough campaign centered on the economy and lacking the votes in the Senate to overturn Obamacare outright, may see little advantage to expending precious capital on blocking further implementation of the Affordable Care Act.

No one thinks Obamacare is the last word on health-care reform. A workable and comprehensive health-care system will have to be hashed out over years. But the current system is costly, inefficient and excludes millions of Americans. Any serious reform has to begin by moving away from the status quo.

What Obama is attempting is to dynamite a decades-old political logjam, and in that, John Roberts has all but ensured his success. Now we can focus on health care’s future.