. . . And this is now, when opponents of the health-care-reform law seem to think that repealing it - or getting the Supreme Court to declare it unconstitutional - will somehow make the problem of nearly 50 million uninsured Americans go away.
And so it is that Republicans in Congress have spent enormous amounts of time on attempts to repeal the act, including a losing vote just last week. But so far, they have avoided explaining what, if anything, they would do instead.
And now Republicans in the Pennsylvania House of Representatives want to get into the act. Despite the pleas of 55 religious, nonprofit and medical organizations, the House health committee yesterday approved a bill to prohibit the state from implementing the individual-mandate provision of the health law. The proposal now goes to the full House.
Such a law could block Pennsylvania from the preparations necessary to enact reform once the law takes effect in 2014 - in particular, creating the health-insurance exchanges, the clearinghouses that will enable people and businesses to shop for insurance.
Of course, an individual mandate would be unnecessary if Congress had passed the most efficient way to provide health care - that is, a single-payer, "Medicare-for-all" program. In exchange for a payroll tax, everyone would get basic medical insurance coverage. Instead, the Affordable Care Act props up the private insurance industry, without so much as a modest "public option" to provide an alternative.
But in order to make it work - to ensure that people with pre-existing conditions can get insurance and can't be dropped if their medical bills get too high - healthy people need to buy insurance and be part of the pool. Otherwise, people would wait until they got sick before paying into the system, and private insurance companies would go bankrupt.
Last week, a federal judge in Florida declared the individual mandate unconstitutional, the second judge to do so (two others have upheld the law). In his ruling, Judge Roger Vinson turned a couple of centuries of constitutional precedent on its head, especially the "Commerce Clause" that gives Congress the power to regulate the national economy, as well as the power that is needed to make the regulations effective. Health insurance represents nearly a fifth of the total economy. If that isn't commerce, what is?
But don't take our word for it. Charles Fried, who was solicitor general under - cue the violins - Ronald Reagan himself, told a Senate committee last week that he's not a fan of health-reform law as public policy, but that it's definitely constitutional. He called the question a "no-brainer" - an apt description of many of the law's critics.
The matter will eventually be settled in the Supreme Court, not in Harrisburg. Maybe House Republicans can enlighten us about how they intend to help the 1.3 million uninsured Pennsylvanians if health-care reform falls through. *