The Health Care Debate: Separating Heart From Head
The Supreme Court case concerning the constitutionality of the Affordable Care Act has sparked quite a lot of discussion on campus. For many people, including myself, the idea of the law being overturned is immensely frustrating. The law will improve the lives of millions, and the idea that it could be voided is tremendously disheartening. This frustration, however, often leads us to focus on the wrong questions. The Supreme Court is not passing a value judgment, but a legal one. In order to defend this law most effectively, we need to be asking ourselves the same question that the Supreme Court is deliberating on: Is the Affordable Care Act constitutional?
At the heart of this question is the individual mandate, the portion of the law stating that everyone must carry some kind of health insurance or face a financial penalty. Those challenging the law deny that the federal government has the authority to regulate the health care market in this way. The federal government derives its regulatory power from Article I, Section Eight of the U.S. Constitution. It states that the federal government has the authority to “regulate commerce…amongst the several states” and can pass all laws “necessary and proper” to achieve these goals.
Now, I am by no means a constitutional scholar, but perhaps we can find the faults in each side’s argument. Those who claim that the law is constitutional point out that health care markets are interstate markets. Health care companies operate in multiple states, people will inevitably use medical facilities outside of their home state, and diseases and infections do not politely remain within political boundaries. By this logic, the federal government is perfectly within its rights to regulate the health care market. The law’s opponents respond that the question of boundaries is not the central issue. They contend that the federal government does not have the power to compel individuals to enter markets or engage in commerce. In other words, people who do not have health care are not in the health care market and are therefore not engaged in “commerce” of any kind. The federal government may have the ability to regulate interstate commerce, but it does not have the power to compel people to engage in it.
The defenders of the law counter that the health care market is unique. All individuals will at some point need medical attention of some kind. Everyone will get sick, need a doctor, or go to a hospital. Therefore, individuals are already part of the healthcare market, regardless of whether they own insurance or not. The government is not forcing anyone to enter a market. It is simply regulating a portion of it that had previously escaped oversight. This argument elicits a more philosophical counter argument from the law’s opponents. Can an individual, simply by being alive, be considered to be engaging in “commerce”? Is the only necessary prerequisite for regulation a heartbeat? Do citizens not even get a choice in the matter? What are the implications for governmental power, personal liberty, and the relationship between state and citizen?
I am simply trying to demonstrate that the question of constitutionality is both more difficult, and more ambiguous, than a value judgment on the idea of universal health care. If the Supreme Court was ruling on whether universal health care was a worthy goal, the fate of the law would not even be in question. Sadly, the Supreme Court does not uphold laws based on their quality or nobleness of purpose, though it might be nice if they did. For those of us who want to see this law upheld, it is not enough to yell that the Supreme Court is dooming the uninsured. It is only by articulating a persuasive case for the law’s constitutionality, not its inherent goodness, that the long sought-after goal of universal healthcare can be achieved.