Less than a year after being passed into law, the Democrats’ health-care reform is under renewed attack on two fronts. In the House of Representatives, the new Republican majority have kept their party’s campaign promise to make repeal of “Obamacare” their first priority, despite the fact that repeal legislation has no chance of passing in the Senate and would in any case be vetoed by President Barack Obama.

Meanwhile, the constitutionality of the Affordable Care Act is being challenged in the courts by those who deny that the federal government has the power to require citizens to buy health insurance (or anything else). Such a challenge is likely to reach the Supreme Court within the next two years.

Since many of the new law’s provisions have yet to be implemented, some of its defenders worry it could be dismantled before it’s had a chance to prove itself. True, the vote on House Resolution 2—suavely titled the “Repealing the Job-Killing Health Care Law Act”—was mostly symbolic. But the threat it symbolized is real enough. To begin with, the vote demonstrated once more how important this issue is to leading Republicans, who regard the passage of health-care reform as both a humiliating defeat to be avenged and a political opportunity to be seized. Confident that most Americans still regard the law as a mistake, Republicans hope to use the promise of full repeal to win back the White House and the Senate in 2012. The repeal vote also signals the intention of the new House majority to sabotage reform by refusing to fund it.

This, they often claim, is a matter of fiscal responsibility: nice as it would be to give everybody health insurance, the government can’t afford it at a time of record budget deficits. Never mind that the nonpartisan Congressional Budget Office says that the new law will actually save the government money. That’s just “their opinion,” according to House Speaker John Boehner (R-Ohio). Conservative think tanks have provided the GOP with another set of numbers, attributing to the Affordable Care Act costs the government would be paying with or without the reform.

But how, conservatives ask, can the government save money while at the same time making itself bigger? Columnist Charles Krauthammer thinks it’s absurd to go about reducing the deficit by adding $540 billion in new spending while increasing taxes by $770 billion. Harvard economist Greg Mankiw jokes that this is like cutting the deficit by getting the government to hand him $1 billion and raise $3 billion in taxes. Neither Krauthammer nor Mankiw denies that the new law will in fact reduce the deficit. It’s just not the way you’d reduce it if you believed, as they do, that all new entitlement programs are self-evidently worthless. As the Washington Post’s Ezra Klein points out, it’s odd that people like Mankiw think insuring 30 million Americans is just like giving away a billion dollars to a well-paid economist.

If the House Republicans had really wanted to save money, they could have voted to repeal only those parts of the Affordable Care Act that increase the deficit and kept the parts that reduce it. Why didn’t they? Because, as a lot of them are candid enough to admit, their opposition to health-care reform isn’t just about numbers; it’s about principle—namely, the principle that in America it’s not the government’s job to make sure sick people can afford medical treatment. Either the free market can solve this problem or it isn’t really a problem.

Those who dispute the legality of the new law attribute the same kind of talismanic properties to the Constitution that free-marketeers attribute to capitalism. In their view, every power the U.S. government will ever need is not only permitted by the Constitution but explicitly provided for by it. If the Constitution does not specifically approve health-insurance mandates, for example, that must be because the Founding Fathers foresaw the dangers of “socialized medicine,” not because the market for health insurance—and indeed all of modern medicine—was something no one could have anticipated in the late eighteenth century.

The individual insurance mandate conservatives oppose, in the courts and in Congress, is an indispensable feature of health-care reform. The government can only require insurance companies to cover sick people as long as it also requires healthy people to buy insurance; otherwise premiums will skyrocket or insurance companies will go out of business. If the conservative legal community were right, then we’d be doomed by the Constitution to a dysfunctional health-care system. In truth, we’re no more doomed by the Constitution than by the market, as long as both are understood to serve the country rather than the other way around. 

Read more of Commonweal's health-care coverage here.