Let’s assume Obamacare is not going to survive its day at the U.S. Supreme Court, at least not intact. It’s intriguing to imagine the landscape 19 years from now, when the federal government takes another shot at health-care reform – that’s been the average gap between failures to make an improvement.

We’ll have fewer Baby Boomers littering the hospital wards, which might make planning easier. But the nation’s mood is unpredictable. After all, a few years back, it was a group of Republicans who insisted that any national health insurance plan had to include a personal mandate to buy.

Who knows where the political pendulum will be?

Some things don’t change much. People who consider themselves healthy and likely to stay that way never want to help pay for the inevitable health-care costs of lazy slobs, and that’s understandable. It’s pretty much socialism.

Of course, that’s what we’re doing now on an informal basis, as the careless class relies on emergency room care and lets everyone else pick up the tab.

Maybe we could come up with a pay-by-virtue system, where the “likely to be sick” pay higher premiums than the “likely to stay well.” Unfortunately, this wouldn’t account for the fact that every day, health-conscious people get surprised by cancer and smashed into by drunken drivers. That’s random chance and irresponsibility at work, and we’ll never legislate our way out of that.

The New York Times’ chief financial correspondent, Floyd Norris, recently suggested: “Anyone who chose not to have health insurance, and not to indicate how they would otherwise pay, would be put on a ‘Do Not Treat’ list. Hospitals could simply refuse to offer any treatment, respecting the person’s wish to make his or her own decisions free of an intrusive government trying to keep them alive.”

We’re not sure if he’s serious or not, but that’s an option.

Everybody used to live that way. And then we came across the idea of “civilization.”