Thursday, June 28, 2012

Musings on the Supreme Court's Obamacare Decision

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 Franklin Roosevelt.

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!

2 comments:

  1. Two things:

    1. On the 1798 act, note that the US constitution explicitly gives the federal government power to regulate everything to do with dock yards. So I suspect this was an easier sell than Obamacare.

    2. I think that Roberts' reasoning makes perfect sense when taken in context. There is no doubt whatsoever that the US constitution gives the federal government the power to raise taxes. The questions are, then a) is the penalty for not buying insurance a "tax", and b) is it okay to tax someone for something they don't do?

    The answer to a) is that there is a long-standing principle that if there are two ways that a law can be plausibly read, and one of them is unconstitutional, then the court is obliged to read it the other way. Even though the act uses the word "penalty" rather than "tax", it can be plausibly understood as being a tax, and since the other way of looking at it is unconstitutional (according to Roberts), the court is obliged to treat it as a tax.

    As for b), there's no shortage of precedent. The US government already taxes people at a higher rate if they don't marry or don't have children.

    I'm not even American, but I thought the decision was extremely well-reasoned. The dissent, by contrast, was almost entirely bluster.

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  2. Thanks for your comment, Pseudonymn. I'll post the relevant part of Article 1, Section 8:

    "To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings..."

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