The news is in about Obamacare! The U.S. Supreme Court has upheld the individual mandate, while allowing the states to decide whether or not they will expand Medicaid. Here and here are good articles that I read on this. And here‘s the text of the opinions (official, concurring, and dissenting).
I haven’t yet read the text of the opinions, but I would like
to eventually do so, for I am interested in the question of whether
it’s constitutional for the federal government to interfere in health
care. I know a number of conservatives who would say “no”.
They’d appeal to the Tenth Amendment to argue that health care is a
state concern. They have characterized the liberal position to be that,
because the Constitution allows the national government to regulate
interstate commerce, that means the national government can regulate anything that affects interstate commerce, such as health care.
But I wonder if there’s more to the story. First of all, when the Supreme Court in 1942 upheld
Franklin Roosevelt’s Agricultural Adjustment Act on the basis of the
U.S. Constitution’s Interstate Commerce Clause (Article 1, Section 8),
did it base its interpretation of the Commerce Clause (the
interpretation being that the national government could limit how much
wheat Mr. Filburn grew on his own field because that affects Interstate
Commerce) on precedent or American history, or (better yet) the views of
the Founding Fathers? I do not know. E.J. Dionne has an interesting article
about how Alexander Hamilton and Henry Clay supported the national
government “ensuring the country’s prosperity, developing our economy,
promoting the arts and sciences and building large projects”. Dionne
also states that Clay and Abraham Lincoln “read the Constitution’s
commerce clause as Franklin Roosevelt and progressives who followed him
did, as permitting federal action to serve the common good.” So perhaps
there were looser interpretations of the Commerce Clause prior to
Second, does the federal government have the constitutional authority
to compel citizens to purchase something like health insurance?
According to this article by Ezra Klein, the U.S. government compelled citizens to buy certain things as far back as George Washington. And,
in 1790 and 1798, the Congress dealt with the issue of a health
insurance mandate for seamen, essentially supporting the mandate.
(UPDATE: See the comments and also here.
The Constitution grants Congress the authority to pass laws that
regulate dock-yards, and that could be the reason that it could pass a
health insurance mandate for sea-men.)
Third, does the federal government have the right to pressure or
coerce states to expand Medicaid? I do not know. I would not be
surprised if the federal government has been telling states what to do
for a long time!
I should point out, though, that there have been different
opinions since the time of our country’s founding, as some supported
more government involvement, whereas others were for states’ rights and a
limited federal government.
In any case, I’d like to read the Court’s opinions sometime to learn more about the different beliefs about these issues.
Am I happy about the decision? Overall, yes. There are elements of Obamacare that I support and also elements that I oppose.
I support the health insurance mandate because it expands the number of
people paying into the system and cuts the cost of emergency rooms
treating the uninsured and passing on that cost to others. I also
support the prohibition on health insurance companies turning away
people with pre-existing conditions because, well, I think we should be
humane. And I’m for Obamacare’s emphasis on preventative care, since
that can prevent costly emergencies. In terms of where I disagree with
Obamacare, it’s primarily on the issue of taxes, since Obamacare raises
taxes on medical-equipment makers and (if I’m not mistaken) health
savings accounts (see here).
I think that the tax on medical-equipment makers could contribute to
higher costs as the equipment makers pass on the costs of the taxes to
their consumers; plus, I believe that the tax could stifle innovation. (But I hope that other elements of Obamacare will offset that and help bring down the cost of health care.)
And I believe that health savings accounts should be encouraged, even
though I disagree with conservatives who act as if they will practically
save U.S. health care.
I cannot say that I understand Chief Justice John Roberts’ view that justifies the health insurance mandate.
He disagrees with the more liberal justices’ justification of the
mandate on the basis of the Commerce Clause, but he says that the
mandate is valid because the national government has the constitutional
authority to tax those who don’t pay the mandate. But I think that
Roberts should first address if the mandate is constitutional in the
first place, before he talks about whether Congress can tax those who
violate it. So I’m pleased with the Court’s decision, but I’m not sure I
agree with Roberts’ way of getting to that decision!
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