Over two years ago, days before the Affordable Care Act was voted on by Congress, Democratic authors of the bill made a swift and fairly quiet adjustment. Initial language in the bill called for a tax to be levied on those who did not already have health care coverage and did not purchase it before 2014, but someone had the bright idea to effectively change the word “tax” to “penalty.” You know, because "tax" is an evil word and leads to losing office.
Two years later, conservatives successfully petitioned the Supreme Court to hear legal arguments surrounding the constitutionality of the individual mandate that is the cornerstone of the Affordable Care Act, or "Obamacare." In the first day of SCOTUS hearings in late March, oral testimony revolved around the Anti-Injunction Act and whether it prevents the court from accepting the case before a citizen has refused to purchase insurance. In all likelihood, if the language had kept the word "tax," the first day of Supreme Court arguments would have been unnecessary, and the tax probably would have been allowed under the power of Congress to levy such things.
But, coming from a self-proclaimed liberal who supports health care reform – and to a certain extent, the Affordable Care Act – the legislation’s individual mandate is unconstitutional. The Commerce Clause – which allows Congress to regulate commerce between states and with foregin nations – has been interpreted so broadly over the years that it bans the personal cultivation of a plant. (Sseriously, Gonzales v. Raich banned a seed-bearing plant that the book of Genesis prescribes as God’s gift to mankind in a blatant attack on freedom of religion). The Commerce Clause should not continue to be used so broadly as to justify a federally-imposed fee should an individual decide not to buy a private commodity. It would seem that the biggest supporters of the individual mandate should be health insurance companies themselves, who would see a jump in 50 million new customers to deny coverage to.
Regardless of constitutionality, the current discourse is an obvious example of the rightward drift in politics and policies over the past decade. The media needs to be more vigilant in pointing out the fact that the mandate, and actually much of the ACA, was the brainchild of The Heritage Foundation – one of the most conservative think tanks in Washington, D.C. It was first introduced to Congress in the early 1990s by a group of Republicans, with some Democratic support. Mitt Romney supported its principles in the Republican Massachusetts’ health care law – endearingly known as RomneyCare and the inspiration for the Affordable Care Act – and helped move the state’s uninsured rate to 2%, compared to over 16% nationally.
It doesn’t sit quite right with me, however, that an individual be mandated to purchase a private good. Currently, American health care and the insurance industry have spawned a for-profit system. A for-profit system, as any laissez-faire red-blooded capitalist can tell you, is about making money for the company and its shareholders; you know, the American Way. An insurance company, whether it be auto, home, or health, is in business to make money. The only way a health insurance company can stay in business is to pay out less in coverage, salaries, and overhead than it makes in premiums. A federal mandate that requires Americans to pad the pockets of the so-called “1%” – the owners of Blue Cross, and Anthem, and Kaiser, and the shareholders in those companies whose capital gains are taxed at a rate that would make George Bush blush – is just another exercise in wealth moving from the bottom to the top.
Now, don’t get me wrong. If the SCOTUS ruling comes down in favor of the mandate’s constitutionality, I will be thankful that the country is on the right track to end the monster that is American health care. But make no mistake – all progressives, and Americans for that matter, should support the move to a single-payer system sooner than later. A ruling in favor of the mandate, and in essence the Affordable Care Act, is likely to keep out a serious national discussion about a single-payer health care system for decades. If the Supreme Court does rule against the mandate, and in essence strikes the legislation from law, the silver lining will be the next round of health care reform. Even Democrats have publicly wished they could start the heath care fight over, and a blank slate would no doubt be a faster track to single-payer.
Why am I so supportive of a single-payer system? Because it will take the aforementioned profit motive out of our health care system. No longer would entry-level employees making $45,000 a year get bonuses for denying medical coverage. No longer would an American’s health be a matter of dollars and cents. Personally, I think a country where a diabetic doesn’t have to choose between medical supplies and college is a good place. Personally, I think a country where a sick infant doesn’t suffer because her mom is in poverty is a good place.
No matter what the SCOTUS decision will be, we win either way.