President Obama is officially optimistic that the Supreme Court will uphold his health-care reform law as constitutional, but many supporters of ObamaCare are less sanguine. Attempting to find a silver lining in the possibility of defeat, some are asking if a "no" decision would pave the way for a single-payer system in which everyone would get insurance through a vastly enlarged version of Medicare. While it would literally mean a government takeover of the health insurance system, a single-payer system does have the benefit of being clearly constitutional. Would a defeat for ObamaCare make single-payer "inevitable"?

Government insurance may be the only option left: ObamaCare, which requires nearly all Americans to obtain insurance, is the only private-sector model that can provide universal coverage and keep down costs, says Sahil Kapur at Talking Points Memo. Without it, America's health-care system "is a road to disaster, with soaring health-care cost projections, growing ranks of uninsured, and rising death rates." If ObamaCare goes, lawmakers will find themselves under "pressure for reform," and single-payer or some kind of public insurance option will be "the only alternatives on the shelf."
"Why overturning 'ObamaCare' could lead to single-payer"

But Congress wouldn't pass it: If ObamaCare is defeated, burned lawmakers of both parties will "shy away from proposing any big changes to the health-care system for the next decade or so," says Ezra Klein at The Washington Post. The government could slowly move toward a single-payer-like system through "incremental expansions" to programs like Medicare, but it would be a "long, ugly process that ensures a very large uninsured population for decades." The best option is for the Supreme Court to simply uphold ObamaCare.
"If ObamaCare is overturned, will that lead to single payer? And would that be a good thing?"

And the Roberts court wouldn't uphold it: Hardly anyone expected the Supreme Court to question ObamaCare's constitutionality, but now the law is in danger, says Jonathan Chait at New York. And Chief Justice John Roberts and Co. are probably "activist enough" to "strike down single-payer, too." The conservative justices will "simply concoct" new arguments "to nullify a much more intrusive big-government system." That makes the political odds of implementing single-payer incredibly daunting: Democrats would need to gain control of every branch of government to pass it.
"What to do if the court strikes down ObamaCare"