With the Supreme Court's decision Monday to review the constitutionality of the Patient Protection and Affordable Care Act's individual mandate that all citizens either purchase health insurance or pay a penalty, the health care reform debate has inched another step closer to a legal resolution. This development threatens to ensnare our political system in ideological and legal minutiae and detract from the law's original intent. It would be better for the Supreme Court to rule based on the Affordable Care Act's moral implications and the novelty of the situation.
In continuing to frame the argument about the individual mandate, we must not lose sight of the reasons for its genesis or its inherent value. We should remember the American health care system's flaws and its drain on our resources. The health care delivery framework that currently exists mirrors the polarization of wealth in America the richest communities have access to high quality services, while the poor often lack any kind of care at all. This shameful access and quality gap is what the Affordable Care Act intends to remedy.
Though its legal justification lies in Congress' power to regulate interstate commerce, the law is really a response to the fact that as many as 50 million Americans currently lack health insurance. It carries a moral imperative grounded in the fact that citizens of the world's most economically advanced nation should not get sick and die simply because they can't afford to be treated. But conservative critics continue to bash the Affordable Care Act, and especially the individual mandate, on the grounds that it is an unwarranted assault on civil liberties. According to this logic, Congress has overstepped its authority by trying to force Americans to participate in an economic activity they would rather avoid. Conservatives' critiques intend to inspire fears of a "slippery slope" that this expansion of federal power will permit future deprivation of civil liberties.
The banter about constitutionality is short-sighted and selfish, and it misses the issue of morality. The legal team from the 26 states that have jointly filed suit against the federal government has already begun to bog down the debate in technicalities by staking its challenge on the grounds that the law will deny Medicaid funding to states that refuse to expand their obligations as the Affordable Care Act envisions. The legal team posits that it unduly "harms" states by forcing them to buy in to continue to receive funding. Such an interpretation betrays cruel disregard for the more evident harm suffered by uninsured Americans, and it is difficult to see the justice in overturning a law that would provide these health benefits.
Furthermore, striking down the individual mandate would set an even poorer precedent with respect to the so-called "slippery slope." Instead of being concerned that this level of government intervention is crossing some arbitrary line, we should worry that a ruling against the Affordable Care Act would lead the government to be less inclined to work on behalf of underserved Americans in the future. What we don't need is another Milliken v. Bradley, a 1974 Supreme Court decision that effectively terminated federal efforts to break the cycle of poverty and poor education in American cities. When this case comes up for review next year, it will undoubtedly be a watershed moment. But it must be the right decision for our times, one in which the U. S. government is permitted to live up to the responsibilities it has to its people.
To that end, the Supreme Court would do well to heed the majority opinion filed last week by Senior Judge and Presidential Medal of Freedom recipient Laurence Silberman '57 of the District of Columbia Circuit Court. Silberman, one of the nation's preeminent conservative jurists, articulated arguments that not only jive morally and legally, but that also recognize the unique circumstances and the need for the government to retain sufficient flexibility for large-scale intervention. He concluded that the number of uninsured Americans and the nature of the health care market have a powerful impact on interstate commerce, and cited his hesitance to rule on a matter that lacks precedent. Most importantly, he acknowledged that the health care market is "factually unique" in that participation is a "virtual certainty" and macro-level problems arise when people decline to participate. This understanding must drive further judicial review of the Affordable Care Act.
