The same forces tried to have struck down all manner of New Deal programmes without which Middle America, rural America and so on could not possibly live now. This is just another one. When even Chief Justice John Roberts, Dubya's nominee, not only says that this is constitutional, but goes out of his way to organise a majority on the Bench to that effect; and when millions of GOP primary voters, of all people, nominate Mitt Romney, of all people, in the midst of this dispute; then it really is all over for the other side.
Why is anyone surprised at this ruling? Supreme Court Justices do sometimes have prior judicial experience, but they are party machine appointees who would never let ideological zeal overcome tactical sense. Strike down the other lot's flagship policy, and they will do the same to yours once the opportunity presents itself. Heaven and earth were always going to be moved in order to rule that, whatever else it might be, ObamaCare was not unconstitutional. So it has been.
Romney has no meaningful intention of repealing something that he himself pretty much invented, anyway. His nomination confirms that, for all the noise from Tea Parties and what have you, the thing that still purports to be conservatism in post-Dubya America is in reality a very small minority concern even among registered Republicans. The result of the primary process speaks for itself. The older school of Eisenhower Republicans will have two candidates out of two in November. Call it ObamaCare, call it RomneyCare, call it anything you like: it is a classic piece of Eisenhower-Nixon-Ford-Bush I Republicanism. America could do with a great deal more such pieces. And the world could do with such an America.
Give it five years - and regardless of the results in November, it will still be there in five years' time - and Americans will wonder how they ever got by without it, if they are still thinking about it at all. The only reform demanded by the public, or suggested by anyone beyond the outermost fringe, will be a move to the Canadian single-payer system (basically, the NHS) advocated by Donald Trump, because it would be so much less bureaucratic while retaining the principle of universal coverage paid for out of general taxation. Assent to that principle will be as universal as the coverage, within five years.
This is also a pro-life victory. A ban on abortion funding was already written into the original legislation, but if this is a tax rather than a commercial purchase then the provisions of the Hyde Amendment also apply, putting the belt and braces on it. Precisely because this is now recognised as taxation, the contraceptive mandate will also almost certainly either be struck down in the courts or legislated away in order to pre-empt any such action.
But we had the NHS a generation before either the Pill or abortion, and they have much tighter abortion laws on much of the Continent alongside, indeed built into, universal public healthcare. So all of that was and is peripheral, if anything, to the principle. And the principle has now been established.