I am not a lawyer by training and hence I'm not going to discuss the legal nuances of the California v Texas decision. The basic gist is Texas/plaintiffs challenged ObamaCare on the basis that the unpopular tax/penalty mandate for minimum healthcare coverage, used as a pretext for financing the program, had been essentially canceled during the Trump Administration by Congress. SCOTUS turned back the appeal 7-2 on the legal technicality of standing.
To be honest, I didn't expect SCOTUS to rule for Texas; clearly the mandate was unconstitutional, but nobody seriously thought the program was going to be funded on the fines for people like me who at points was unemployed and couldn't afford $800 or more/month for health insurance. I, of course, worried about developing a severe, rare, costly disease, but it was a lot easier and cheaper to pay a doctor or clinic a $125/visit fee as needed every few months. Now I've been employed every year with health insurance during the ObamaCare period. I recall that I had to figure out some sort of prorated penalty for months when I was unemployed, and that wasn't fun, even for someone with two math degrees. Now a couple of years back I got terminated by a thin-skinned employer literally later the same day I had requested time-off for a scheduled eye surgery. so of course I had to go onto overpriced COBRA. I think though by then the Congress had eliminated the fee. I remember at the time I did have to pay the penalties thinking how unfair it was: I still had to pay for my out-of-pocket expenses out of post-tax earnings/savings but I was being forced to subsidize other people's health coverage.
While in the process of writing this post, I've seen a recurring ObamaCare ad on television suggesting as low as $10/month (net of tax credit).coverage for most eligible applicants. Now the federal government collects nearly $4T in revenue yearly, not to mention can tap into trillions of dollars via Treasury bonds/notes, so I never bought into the fiction of a lockbox (it's also been financed by an expansion of Medicare tax payments from the wealthy, taxes on certain medical devices, etc.) It has had a huge toehold in the health services sector, especially since Medicare/Medicaid, since the 1960's. And of course it has provided a tax-free basis for employer-sponsored health insurance since the FDR Administration as employers looked for a way around wage-price controls to attract workers. This, unfortunately, had some unintended consequences as insurance morphed into a health services construct exacerbating inflationary pressures as consumers became disconnected from vested efficient decision-making.
I never bought into the preexisting conditions talking point, but the Republicans seemed to be sensitive to the allegation of throwing people off insurance and bought into the hubris of "repeal and replace" (the issue wasn't with repeal). ObamaCare, by any objective standard, has been a failure as the overregulated marketplace has deteriorated: fewer vendors; under-enrollments, higher premiums and deductibles, among other issues. I'm not going to go into detailed policy alternatives here; I would refer the interested reader to free market policy principals, like Michael Cannon of the Cato Institute and John C. Goodman of the Independent Institute, that I've cited many times over the history of this blog. I've always felt that government policy has been the problem, not the solution, and a national system over the traditional decentralized, state-based health regulation was not the way to go. I thought there were ways to extend healthcare coverage across state lines (especially for sparsely populated states) and/or reinsure assigned risk pools.
What is the solution? Not a government monopoly. You run into deadweight costs of taxation, never mind the fact that the central government simply is an incompetent surrogate for 330M consumers and David Friedman and others point out the government will often spend up to 50% or more higher in related expenditures. I'll refer the interested reader to Mises' discussion of the calculation problem and the tragedy of the commons problem in the public sector, not to mention problems like regulatory capture in our mixed economy. Government stifles cost-cutting innovation and impedes competition. Price floors and ceilings typically result in surpluses and shortages respectively. Just look at the incompetence of government during the pandemic; it did not include the private sector in COVID-19 testing, and its own rollout was delayed and ineffective. And the vaccination rollout was slow and delayed vs an attempt to ramp out First Dose First and alternative dosage strategies (see Alex Tabarrok of Marginal Revolution for more discussion).
