Conservatives have generally favored changing the tax treatment of health care so that, among other things, individually-purchased health insurance would be treated the same way as employer-provided insurance. That change could be expected over time to cause many employers to drop their coverage, raise their employees’ wages, and send them out on the newly enlarged individual market. The biggest political drawback to this idea is that it would be disruptive: It would threaten people’s existing employer-provided coverage, with which they are generally happy. This disruption opens a line of attack for liberals, and they have exploited it.

For that reason, some conservative health reformers have argued that we should go slow on any changes in the tax treatment of health care, expanding the individual market (and shrinking the employer-based market) only gradually. One idea might be to allow a tax break for individually purchased insurance only for people whose employers haven’t provided coverage in the past, or who are unemployed. This go-slow approach would sacrifice some of the potential gains from a clean break with existing policy. People with employer-provided coverage wouldn’t gain much portability, for example. But the go-slow camp says that a faster reform is politically unrealistic.

The way the current debate has unfolded suggests that they are right. Note that in the Heritage Foundation’s list of Obamacare’s drawbacks, the threat to existing arrangements is the first item mentioned. If Obamacare is defeated, that type of inertial conservatism will have played a big role, and the prospect for a big-bang free-market reform will recede even further.

Of course there isn’t much point to having this debate right now, since people who want to move toward a truly free-market approach have no power in Washington. Some day, though, they might, and at that point they will have to have out this debate.