Wednesday, April 4, 2012

The Constitution of the United States and healthcare

Last week the U.S. Supreme Court heard the arguments for and against the Affordable Care Act (ACA).  The justices probably met in private on Friday, during which meeting they would have cast their votes on the issue of the Act's constitutionality.  After the voting, one justice was probably given the responsibility to write the opinion of the majority, and one or more dissenting justices would be assigned to write dissenting opinions.  It's not likely that we will know those results before the end of June.

There's no telling how this will come out.  But, it has caused me to pick up a copy of the Constitution and seek out the portion of it--the so-called "commerce clause"--that is often cited as being at the heart of whatever decision will be rendered.

As it turns out, the commerce clause is a mighty small piece of text to be at the center of such a huge maelstrom.

This clause is in Article I, Section 8.  That section begins with the words "The Congress shall have the power. . ." and then it continues with a pretty extensive list of things that Congress is empowered to do.  One of those items reads in this way:  "To regulate commerce with foreign nations, and among the several states, and with the Indian tribes."

So, Congress clearly has the power to enact legislation that regulates commerce among the states. 

But, this controversy over the ACA quickly gets hung up in its own knickers when we start talking about the nuances of the commerce clause, such as the definition of "commerce" and just how healthcare and the purchase of healthcare insurance--or the lack of purchase of healthcare insurance--are encompassed, or not encompassed, within that definition.

It seems to me--after reading the commerce clause--that the ACA does not violate it.  But, different people have different opinions, and we will eventually hear what the Supremes have to say on this subject, but probably not for several weeks yet.

In the meantime, all of this has me wondering about the Constitution itself.  It was written almost two and one-half centuries ago, and the country and the world were very different then than they are now.  Much has changed since the late 1780s.

In many ways, the Constitution is a marvel of conciseness.  As such documents go, it's really pretty short.  It's pithy, too.  The Constitution manages to create the framework for a democratic government that has been successful in running a country that has changed and grown in ways that the writers of the Constitution could never have anticipated.

In some ways, the Constitution is clearly archaic and even erroneous.  For example, my quick scan of the Constitution reveals at least two mentions of "letters of marque."  How many people these days know about letters of marque?  Very few, would be my guess.  Such a letter would authorize a privately-owned, armed ship to attack shipping flying the flag of an enemy nation.  The last time this was authorized by the United States was two centuries ago.

The Constitution doesn't mention healthcare or health insurance; those are concepts of the 20th and 21st centuries.  However, the writers of the Constitution were wise enough to begin it by asserting that one of the reasons for creating the Constitution was to "promote the general welfare."  That sounds to me like an 18th century concept that would encompass the health and well-being of the country's inhabitants.

It also doesn't mention an air force, although it describes the army and the navy.  Nobody towards the end of the 18th century was even dreaming about military flying machines.  But I don't think the constitutionality of the air force has ever been in question, nor should it be.

Fortunately for the people of the United States, the Constitution was written in such a way that it has been able to adapt and expand so as to accommodate the growing needs of a growing country.

There were no flying machines in the 18th century when the Constitution was written, but it does not trouble us now that we have a national flying machine air force.  There is no reason to be troubled by this -- ideas, concepts, science and technology have changed, and our needs have changed, and so the government that is the result of that Constitution has changed.  Makes sense to me.

Today's ideas, concepts, science and technology for healthcare are vastly different from what they were when the Constitution was written.  Our personal needs have changed over time, too, as our awareness of health has changed.

There's no reason why the Constitution cannot continue to provide an evolving framework for supporting our needs for healthcare, just as it provides an evolving framework for meeting our national defense needs for flying machines.  That's an idea that certainly seems to make a lot of sense, too.

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