06/29/2012 08:51 am ET Updated Aug 29, 2012

Health Care Confusion

To the surprise of nearly everyone -- including me -- the Supreme Court declined to vacate Obamacare, declaring that the mandate was justified as a tax. This opens up a whole new can of worms with respect to both the substance and politics of the health care bill. None of the legal experts expected the mandate to be justified as a tax, but all the Republicans argued from the beginning that it was. The stock market sell-off after the decision was announced reflects confusion about the implementation of the bill, and concern that it's going to cause firms to decrease employment.

The health care issue is clearly one that should be decided in the political arena. For better or worse, anything as comprehensive and pervasive as health care reform really must be based upon a consensus. For example, the Civil Rights Act of 1964 was perhaps even more volatile than Obamacare, but in the final hours our leaders in Congress came together to create at least a patina of unity. The Republicans realized that if the historic civil rights law was strictly a Democratic measure, it would have little credibility and would foster endless dissension in the land. To their everlasting credit, they dropped their objections and fell into line.

Regrettably, Obamacare did not receive any such sanction. It was never very popular with the public and squeaked through Congress on almost a totally partisan vote. The Republicans, responding in part to public opinion polls, dug in their heels and fought it all the way. In the subsequent election, the voters gave Republicans a fresh majority in the House, suggesting they were more in tune with the electorate than the Democrats were, at least on health care reform.

Overall, I put primary blame on the White House. The President and his team were more interested in victory than consensus. The result was not only a partisan bill but an unbalanced one that did almost nothing to address the primary problem with health care - soaring costs. To the contrary, in his quest to expand health insurance to everyone the President made certain that health care costs will rise even faster in the future.

Now that the battle lines are more sharply drawn, with the mandate justified as a tax, opposition to the bill will surely escalate. But, if the voters want to get rid of Obamacare, they will have to do it at the polls. I believe it is safe to assume that this will be a critical issue in the campaign, rivaling that of the economy.

We still need substantive reforms of the health care system, but the critical element must be cost reduction. This means that the opponents of Obamacare need to put a viable alternative on the table that does reduce costs and gives the voters a real choice. Now that would be a campaign we could all get interested in.

Jerry Jasinowski, an economist and author, served as President of the National Association of Manufacturers for 14 years and later The Manufacturing Institute. Jerry is available for speaking engagements.