Conservatives fought Social Security, Medicare and the weekend when they were proposed. But once enacted, Republican and Democratic Presidents embraced all three as they became part of American life.

We can expect President Obama's court-tested health-care reforms which shift payment for uninsured people's health care from hospitals to taxpayers will also go on, even if Republican Mitt Romney is elected President.

Veteran Philadelphia investor James M. Meyer, of Tower Bridge Advisors, which manages $1 billion in other people's money, wrote a thoughtful account of the costs, purpose and likely durability of "Obamacare," in a note for clients of the West Conshohocken-based investment brokerage Boenning & Scattergood:

"Republicans want to repeal the law. Indeed, the House will vote on or about July 11 to try and do just that. Almost certainly a repeal bill will pass, but just as certain it will die a quick death in the Senate.

Mitt Romney has suggested that repeal of ObamaCare would be his first Presidential initiative if elected. But that is probably just rhetoric.

Outright repeal without a realistic alternative isn't going to sit well with the public. Few want to go back to a world where insurers can simply reject high-risk patients, where people can't [change] jobs for fear of losing coverage, or where children under 26 can no longer be covered on their parent's policies.

Instead, what are needed are mechanisms to make our health-care system more cost efficient. That requirement is going to be the same whether Obama or Romney is elected."

More insurance will bring more taxes a surcharge on investment income for higher-income Americans, and a tax on medical gadgets, though U.S. Rep. Jim Gerlach (R., Pa.), with device-makers in his district, wants that canceled.

It will cost many billions to extend Medicaid and subsidize insurance sold through state exchanges to the self-employed, workers at small firms, and others whose bosses don't insure.

The government has to attack rising costs, Meyer wrote. Suppliers need incentives to sell the "right" level of health care. Not just more health care. "The patient needs to have an economic stake in the decision to spend money on health care," he wrote. Maybe offer a menu of cost-benefit packages, like in Medicare Part D; incentives for health living; or vouchers.

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Philly Deals: With Romney or Obama as president, health-care reforms are here to stay