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Samuel Gregg on the Supreme Court and the Individual Mandate
Samuel Gregg on the Supreme Court and the Individual Mandate
Jan 18, 2026 8:02 AM

In response to the Supreme Court ruling on Obamacare’a individual mandate, National Review Online launched a symposium — a roundup mentary — which posed the following question: “What’s next for both conservatives and the Republican party on health-care reform?” Acton Research Director Samuel Gregg contributed this analysis:

Leaving aside the arguments that will continue about the SCOTUS ruling on Obamacare, one response of those who favor free markets and limited government must be for them to start preparing themselves for what will eventually happen, regardless of the results of the 2012 presidential election. And that’s Obamacare’s eventual economic demise. The economic track record of socialized medicine is very clear. Sooner or later, it implodes. Britain’s National Health Service is a perfect example. Even Sweden has realized that socialized medicine (and generous welfare states more generally) are unaffordable in the long term, and it has begun allowing private providers into its health-care market. In short, Obamacare’s essential economic unfeasability and extensive bureaucratization of health care (not to mention its disproportionately negative impact on the poor) will e all too clear in time. When that happens, conservatives must have off-the-shelf plans ready to go in order to restore sanity to the asylum of socialized medicine.

However, it’s also plain that conservatives, beyond citing the raw economics of real health-care reform, must ballast their case against socialized medicine with moral and cultural arguments. Far too many conservatives and free marketers critique socialized medicine almost solely in terms of efficiency and effectiveness. Economic analyses and arguments are important, but not many people will put everything on the line for a calculus of utility. Instead, critics must draw attention to the ways in which socialized medicine (1) saps personal responsibility, (2) facilitates the spoiled-brat entitlement mentality presently reducing much of Europe to an economic laughingstock, and (not least among such concerns) (3) creates an impossible situation for those of us who on grounds of faith and reason cannot and will not participate in schemes that legally require us to cooperate in other people’s choices for moral evil.

We can win numerous economic arguments. In some respects, that’s actually the easy part. But until we decisively shift — and win — the moral debate, the battle will be uphill all the way.

Read other viewpoints on NRO’s “What’s Next for the Opposition?”

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