Saturday, July 7, 2012

Health care, the Supreme Court, the Constitution and the Founding Fathers

Obamacare is constitutional.  The Constitution of the United States is fully intact.  The Founding Fathers are long gone.  Things are a lot different now than they were in the 18th Century.  

At the end of June the U.S. Supreme Court published its ruling on the legal cases challenging the constitutionality of "Obamacare" and has found that the legislation is constitutional after all.

Lost in the ensuing hub-bub was a reaction of "What just happened?!?"

That's what you are reading now.

The Supremes have ruled that the Affordable Care Act is constitutional.  What the dickens is going on with this?

Don't misunderstand me -- I'm pretty pleased with the decision, even if I'm not entirely satisfied with the legislation itself.  But that's for another time. 

What's got me befuddled is the reasoning behind the dissenting view of the minority opinion from the Court.  It's a view that seems to use the Constitution as a method of obscuring reality.

In a nutshell, the conservative Justices on the Court seem to believe that Congress does not have authority to regulate health care in this way because healthcare and healthcare insurance do not fall under the commerce clause of the Constitution.  The Chief Justice apparently feels the same way, but his view is that Obamacare is OK because it relies on a tax to mandate coverage, and the Constitution clearly grants taxing authority to Congress.  The liberal side of the Court came down on the side of saying that this is interstate commerce, and so it's within Congressional authority as set forth in the Constitution.   My guess is that they are good with the concept of taxation authority, too.

So, we ended up with 4 "nays" and 5 "yeas," where the majority voted to uphold the ACA for two different reasons.  That's a blended verdict on one of the most monumental cases to come before the Supreme Court.  By itself, that's a noteworthy event.

But back to the minority view.  Which is actually the majority view, when you count the Chief Justice along with the four justices voting in the minority.  And they say that healthcare is not a form of interstate commerce.

That is a view that seems to fly in the face of reality.  Perhaps they are saying something different.  Maybe they are saying that the Constitution's expectations of interstate commerce have simply never encompassed healthcare.

And here I thought this was all about the requirement that everybody have health insurance, or be faced with a penalty or a tax as an alternative.  Which brings us back to the Chief Justice, and his tax idea.

It's complicated.

The reality of healthcare is that it is interstate commerce.  We all know that because we buy our healthcare insurance with the expectation that it will be honored, if needed, in any state in the country.  When we travel from one state to another that notion is an implicit part of our travel plans and actions.  Health insurance is a part of any decision to travel to various renowned medical treatment centers in a variety of different state locations for specialized care.

Healthcare and healthcare insurance is just as much interstate commerce as is putting a load of California oranges in a train car and shipping the fruit to some other state.  These things go on all the time.

But five out of nine U.S. Supreme Court Justices see it differently, and so do a lot of other people.  I don't get it.

Maybe the basis for this idea is that a strict interpretation of the Constitution leaves out healthcare.  Perhaps so.  I don't see it that way, but if someone can enlighten me to the logic of that idea, I'd like to hear it.

It's true that the Constitution, as written, does not take into literal consideration lots of things.  Maybe healthcare is one of them.  So is the Air Force, because people weren't flying around back in the 18th Century when the Constitution was written.

The country is a lot different now than it was over two hundred years ago.  So is the entire world.  We were an agrarian nation at that former time.  Not so now.  Today the USA is "industrial" or "post-industrial," depending on your point of view.

We can guess at what the Founding Fathers and the authors of the Constitution might have been thinking when they formed the nation and wrote the Constitution, and some of that will be educated guessing because of other documentation that they left behind.

But it's almost impossible to interpret the Constitution by always saying that the most important thing is to assess what was the original intent, because the Founding Fathers and the authors are all gone.  They're dead.  They have been dead and gone for a very, very long time.

During that very, very long time things have changed a whole lot.

The Constitution can probably keep working for us as long as it remains open to adaptability through interpretation.  It must be adapted to changing times and changing needs.

If I were to be a Supreme Court Justice, that would be my guiding principle about the intent of the Founding Fathers and the authors of the Constitution -- that it must adapt to changing times and changing needs of the country.

Washington, Jefferson, Adams, Madison, Franklin and all the others were aware that they were living during a time of change.  They were causing change.  My belief is that they expected that the country would change, and the foundations of the nation would have to change, too, so as to be able to continue to provide support for America's laws and governing institutions.

My interpretation of the original intent of the Constitution is that change was expected because they couldn't know everything that would need to be written into the Constitution.

And maybe that's why the thing was written with lots of big and general words and concepts.  "Commerce" means a lot of different things.  Among which is healthcare.

At least until something better comes along.





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