In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform.

Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well.

Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform.

So, what next? I don’t pretend to have a crystal ball, but all analyses point to a showdown in the Supreme Court, with Justice Anthony Kennedy being the ultimate decider.

Striking down the Affordable Care Act would be a shame. As a wrote previously, Conservatives shouldn’t be so enthusiastic about the prospects of repeal. If health reform was completely abolished, health premiums would continue rise unabated, along with health costs consuming a larger piece of the GDP. That very likely would lead to an expansion of Medicare and Medicaid — which would be a far worse fate for the those who worry about a government takeover of health care.

There’s a reason why the health insurers haven’t been vocal supporters of repeal. From their end, the Affordable Care Act is a positive outcome.

And for patients, complete repeal of the law would be harmful. According to the ACP’s Bob Doherty,

Repeal, of course, would also eliminate all of the provisions of the ACA, including rules to end discriminatory practices against people with pre-existing condition exclusions, coverage of adult children on their parents’ plans, the new 10% increase in Medicare payments to primary care physicians, the new Medicare wellness examination preventive and other screening procedures now available free of charge to beneficiaries, the phase-out of the Medicare Part D doughnut hole, the requirement that insurers spend more on patient care and less on administration, and much, much more.

I continue to stand against repealing health reform. It is far from perfect, obviously. It doesn’t do nearly enough for primary care, and has only token efforts at reforming our malpractice system. Conservatives would better serve the public if they worked on including their principles in the Act, tort reform and an expansion of health savings accounts for instance, rather than lobbying for repeal.

After experiencing the debacle of constructing the Affordable Care Act, it’s unlikely that either political party would touch health reform for the foreseeable future, should we need to start over.  Thus, we’d be stuck with an unsustainable status quo.

Should Conservatives  succeed in repeal, that, ironically, would be the first steps towards a Medicare for all, single payer system, which would be an infinitely worse proposition for them.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.