Conservatives were dismayed by the Supreme Court’s ruling on health care reform Thursday. But in fact, Chief Justice John Roberts, the swing vote, was the court’s only member to act in truly conservative fashion.

He did this in at least two ways: He followed the conservative call for justices to demonstrate judicial restraint, looking for ways to let laws passed by democratically elected representatives stand if possible. At the same time, he delivered a landmark blow to liberals’ broadening of the Constitution’s Commerce Clause, taking away one of the primary vehicles for the federal government’s expansion.

In ruling the way he did (and it was his ruling), Roberts created another conservative-friendly reality: Voters are back at the top of the food chain. Only elections can do away with health care reform now.

Stymied by the nation’s highest court, Mitt Romney and Republican congressional leaders reiterated Thursday that repealing the Affordable Care Act will be their first order of business. So Americans have a clear choice in November: Whether to give Republicans control of the House, the Senate and the Oval Office and thus ensure the death of health care reform.

That’s a question that forces voters to decide whether they want to go back to a system that leaves 50 million people uninsured in the world’s richest country. A system that denies insurance coverage to — or even drops coverage from — the very people who need it most. A system that enriches insurance and pharmaceutical companies at the expense of regular folks. A system in which if you lose your job, you lose your insurance, and could be on the road to bankruptcy. A system that allows insurance companies to limit how much they will pay in benefits over a customer’s lifetime.

That’s what would be at stake with repeal. What would replace current law is anyone’s guess, because reform opponents haven’t said. Precious little, most likely.

Critics plan to build support for repeal by labeling the Affordable Care Act as a giant tax increase on the American people. In fact, it will only be an increase for the 4 million or so people (out of 311 million) who can afford health insurance but choose to risk not having it. And they are merely being forced to pay into a system that they will eventually need, rather than foisting their costs onto the rest of us. (Which is the rationale, incidentally, that prompted conservatives to create and for years support the idea of an individual mandate before President Obama adopted it as a compromise.)

Obama’s health care reform only began to tackle the problem. It provides coverage to millions of people who wouldn’t otherwise have it. But it does little to slow rising medical costs, eliminate waste or improve health outcomes. Congress should focus on those challenges, rather than on repealing a measure that has now been approved by all three branches of government. They might also focus on saving Medicare, which is barreling toward insolvency.

Chief Justice Roberts pulled off a three-fer on Thursday. He protected vitally important legislation, and did so in a way that confirmed his reputation as a true conservative. And in doing all this, he avoided eviscerating the Supreme Court’s reputation as an institution above the political fray.