Health care reforms put forward by U.S. President Barack Obama have passed constitutional scrutiny. In an anxiously awaited, bitterly divided 5-4 ruling, the U.S. Supreme Court ruled the week before last that the bulk of the bill, put into law in 2010, can go into effect.
The decision upholds the most important piece of social legislation put forward in the United States for decades, but in a sad commentary on the static perspective of many Americans, the overwhelming majority of the commentaries and analyses have focused on the politics of the decision, rather than on its impact on health care in the country.
Experts and specialists have long called for reform of the U.S. health care system. President Bill Clinton tried to implement change in his first term in office nearly two decades ago, but that effort failed miserably. By the time Mr. Obama took office, the U.S. was spending 17.6 percent of its GDP on health care — more than any other developed country — an amount that had steadily risen from 12.4 percent in 1990.
While U.S. politicians claim that theirs is the best health care system in the world, statistics tell another story: Average life expectancy in the U.S. is below the Organization for Economic Cooperation and Development (OECD) average; its infant mortality rate is 43rd among nations; the U.S. has the highest rate of obesity among the 34 developed nations, a fact that anticipates more disease, such as heart disease and diabetes, later in life; health spending per person is more than twice that of other wealthy nations that have universal health care; and perhaps most damning of all, an estimated 50 million people do not have health insurance, while it is reckoned that half of all bankruptcy filings in the U.S. are the result of health care bills.
Yet, almost immediately after Mr. Obama signed the Patient Protection and Affordable Care Act (ACA), more than half the state governments in the U.S. filed suits to overturn the law. They alleged that the law’s mandate that individuals buy health insurance or pay a fine was an unconstitutional assertion of federal government power — that it could not force individuals to take part in economic activity. They also charged that the law’s expansion of Medicaid — a program for low-income individuals — was coercive insofar as a state’s failure to abide by the new rules would forfeit federal Medicaid funds.
On June 28, the last day of the court’s term, the decision came down. As anticipated, it was a 5-4 decision. Surprisingly, the swing vote was Chief Justice John Roberts, a conservative who was anticipated to have opposed the law.
Instead, he wrote the majority opinion that concluded that while the government could not compel people to engage in economic activity — such as mandating them to buy insurance — it could tax people who did not. (That the government preferred to not call its actions “a tax” was irrelevant; long-standing judicial principles urge judges to find reasons to support legislative action.) A 7-2 majority struck down the expansion of the Medicaid program, agreeing that such action was overly coercive.
The decision prompted predictable responses. Republicans, who have opposed the law since it was first proposed (even though they backed individual components such as the mandate during the Clinton effort), continued to insist that it was a socialist program that constituted government over-reach, would hurt the economy and would harm the provision of health care in the U.S.
Leaders of the party, including Mr. Mitt Romney, the presumed GOP presidential candidate who will challenge Mr. Obama in the November elections, have vowed to repeal the law on the first day of the new administration.
On the other side of the aisle, Democrats exulted in the constitutionality of Mr. Obama’s signature legislative proposal for his first term in office.
Most commentary since the decision has focused on its political impact. There is agreement that the Republican base will be galvanized by the ruling and more eager than ever to get out in November to defeat Mr. Obama.
Since this group has vehemently opposed Mr. Obama, this may not have such an impact on the November vote, especially because the ruling validates the constitutionality of the law — even Mr. Karl Rove, eminence grise of the Republican Party, conceded that the decision was “a boost for the president” — and has resulted in higher support for the reform.
The ruling and Mr. Roberts’ role in it undercut perceptions that the Supreme Court has been politicized. Once the most respected institution in U.S. politics, its status has eroded since the 2000 Bush v. Gore decision.
There were fears that if a 5-4 decision had struck down ACA, it would have reflected the court’s own internal divisions and caused great damage to its credibility and standing within American society.
While Mr. Roberts, a conservative jurist, is now seen by many on the right as a traitor, his ruling both supports the image of the court as a neutral arbiter of law and, for some scholars, advances a conservative agenda of limiting the reach of executive authority.
Lost amid the scoring, however, is the real life impact of the decision. ACA offers new security to tens of millions of Americans who did not have access to health care before. That fact alone should have made action imperative.
Moreover, over time, the law is anticipated to hold down those soaring health care costs. Reining in that spending should help put the U.S. economy on stronger footing as it grapples with recession and the uncertainty that it has created.
Health care reform, done properly, can make the U.S. economy healthier.
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