How ideology shapes our understandings of legality:
[T]here are vanishingly few people who believe that the Affordable Care Act was a terrific piece of legislation except that it is unfortunately unconstitutional. Nor are there more than a handful who believe that the ACA is certainly permitted by the Constitution, but is otherwise a terrible idea. … What should we learn from all of this? Mostly, that we shouldn’t take at all seriously anyone’s protests that what they’re doing is driven mainly by Constitutional doctrine.
For my part, I may just fit into the first category. I have no expertise in constitutional law so cannot say either way on the ACA's constitutionality. But as a principle, having the federal government forcing me to buy something I might not want does rub me the wrong way. But since there are clear collective consequences of my refusal to buy insurance and yet expect adequate treatment if I were to get squished on my bike by a truck, I can see the need for mandatory insurance, as with cars. This is about ending free-riders and ensuring personal responsibility – which is why the individual mandate was once regarded as a clearly conservative proposal.
But my main reason for supporting the ACA is pretty simple. The private sector has been given a chance to show it can deliver healthcare efficiently – and it has failed to such a spectacular extent that government has little choice but to try and prevent this sector bleeding the rest of the economy dry. Compared with more collective, socialized systems, the cost of the US system to achieve the same results is gob-smacking. Hence the cost-control reforms. The private sector, moreover, simply won't work for someone like me with a chronic condition, who couldn't get a personal private insurance policy if I tried.
In what other business is the private sector so vastly less efficient than the public? I suspect those businesses where consumers are vulnerable – because they know nothing compared to the seller, or because they desperately need help. Both apply in spades to healthcare.