Charles Krauthammer

WASHINGTON -- Obamacare dominated the 2010 midterms, driving its Democratic authors to a historic electoral shellacking. But since then, the issue has slipped quietly underground.

Now it's back, summoned to the national stage by the confluence of three disparate events: the release of new Congressional Budget Office cost estimates, the approach of Supreme Court hearings on the law's constitutionality and the issuance of a compulsory contraception mandate.

Cost:

Obamacare was carefully constructed to manipulate the standard 10-year cost projections of the CBO. Because benefits would not fully kick in for four years, President Obama could trumpet 10-year gross costs of less than $1 trillion -- $938 billion to be exact.

But now that the near-costless years 2010 and 2011 have elapsed, the true 10-year price tag comes into focus. From 2013 through 2022, the CBO reports, the costs of Obamacare come to $1.76 trillion -- almost twice the phony original number.

It gets worse. Annual gross costs after 2021 are more than a quarter of $1 trillion every year -- until the end of time. That, for a new entitlement in a country already drowning in $16 trillion of debt.

Constitutionality:

Beginning March 26, the Supreme Court will hear challenges to the law. The American people, by an astonishing two-thirds majority, want the law and/or the individual mandate tossed out by the court. In practice, however, questions this momentous are generally decided 5 to 4, i.e., they depend on whatever side of the bed Justice Anthony Kennedy gets out of that morning.

Ultimately, the question will hinge on whether the Commerce Clause has any limits. If the federal government can compel a private citizen, under threat of a federally imposed penalty, to engage in a private contract with a private entity (to buy health insurance), is there anything the federal government cannot compel the citizen to do?

If Obamacare is upheld, it fundamentally changes the nature of the American social contract. It means the effective end of a government of enumerated powers -- i.e., finite, delineated powers beyond which the government may not go, beyond which lies the free realm of the people and their voluntary institutions. The new post-Obamacare dispensation is a central government of unlimited power from which citizen and civil society struggle to carve out and maintain spheres of autonomy.

Figure becomes ground; ground becomes figure. The stakes could not be higher.

Coerciveness.

Serendipitously, the recently issued regulation on contraceptive coverage has allowed us to see exactly how this new power works. All institutions - excepting only churches, but not excepting church-run charities, hospitals, etc. -- will be required to offer health care that must include free contraception, sterilization and drugs that cause abortion.

Consider the cascade of arbitrary bureaucratic decisions that resulted in this edict:

(1) Contraception, sterilization and abortion pills are classified as medical prevention. On whose authority? The secretary of health and human services, invoking the Institute of Medicine. But surely categorizing pregnancy as a disease equivalent is a value decision, disguised as scientific. If contraception is prevention, what are fertility clinics? Disease inducers? And if contraception is prevention because it lessens morbidity and saves money, by that logic, mass sterilization would be the greatest boon to public health since the pasteurization of milk.

(2) This type of prevention is free -- no co-pay. Why? Is contraception morally superior to or more socially vital than -- and thus more of a "right" than -- penicillin for a child with pneumonia?

(3) "Religious" exemptions to this edict extend only to churches, places where the faithful worship God, and not to church-run hospitals and charities, places where the faithful do God's work. Who promulgated this definition, so subversive of the whole notion of godliness, so stunningly ignorant of the very idea of religious vocation? The almighty HHS secretary.

Today, it's the Catholic Church whose free-exercise powers are under assault from this cascade of diktats sanctioned by -- indeed required by -- Obamacare. Tomorrow it will be the turn of other institutions of civil society that dare stand between unfettered state and atomized citizen.

Rarely has one law so exemplified the worst of the Leviathan state -- grotesque cost, questionable constitutionality and arbitrary bureaucratic coerciveness. Little wonder the president barely mentioned it in his latest State of the Union address. He wants to be re-elected. He'd rather talk about other things.

But there's no escaping it now. Oral arguments begin Monday at 10 a.m.

(c) 2012, The Washington Post Writers Group