June 23--President Barack Obama's opponents have invested more than $200 million to persuade Americans to oppose his health care reforms. It's working. On the eve of the Supreme Court's ruling, a majority say they hope the court strikes down the president's signature domestic achievement.

It's a classic case of: Watch what you wish for. The alternatives under discussion are far worse, unless you're rich and can pay out of pocket for whatever care you need.

The federal mandate to buy insurance is at the heart of Obama's plan and the court challenge. The idea came from the conservative Heritage Foundation, and it is integral to the successful reforms instituted in Massachusetts under Mitt Romney, although he now renounces them. Obama turned to the mandate because it was the only way in today's political climate to create an insurance pool big enough to cover all Americans. He knew the nation wasn't, and might never be, ready for the progressive alternative of a taxpayer-funded, government-run single-payer system.

Americans presumably want health insurance. But the plans touted by Republicans would leave an estimated 30 million without coverage and millions more with worse coverage than they have today.

Romney's website asks: "When was the last time a massive government program lowered cost, improved efficiency, or raised the consistency of service?" The answer is: Medicare. Forty-seven years after it was enacted, 80 percent of Americans

believe Medicare has "been good for the country." How many politicians have that kind of approval rating?

Medicare covers 48 million Americans at significantly lower administrative costs than private insurance. It has its flaws, but its cost-per-beneficiary has risen at a considerably lower rate than private insurance premiums.

Romney has no plan to help Americans denied coverage because of pre-existing conditions. He touts health savings accounts, but federal Government Accountability Office studies, among others, conclude that they benefit high-income individuals at the expense of the middle class and poor. Romney's plan would force nonwealthy families into plans with far greater out-of-pocket costs than most insurance plans today.

Romney also would let people purchase insurance across state lines, so that states can't set standards for their residents. Insurers will flock to the state with the fewest regulations, and low quality plans will become the norm.

The GOP touts tort reform, limiting malpractice lawsuits, to cut costs -- like Texas Gov. Rick Perry's ballyhooed reforms. But a University of Texas study released Wednesday found no evidence that they had any effect on health care costs. Other studies estimate a 1 percent savings at most from tort reform.

If Obama's reforms survive the Supreme Court, they'll be just a start. More needs to be done to cut costs, for one thing. But the GOP alternatives will mean poorer coverage and more uninsured Americans -- the very problem Obama set out to remedy. Just in time for the fall presidential campaign.

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(c)2012 the Contra Costa Times (Walnut Creek, Calif.)

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