A Victory For Balance

 

I’m always intrigued by the social media discussions that we are now privy to when historic news breaks, such as today’s Supreme Court decision in NFIB vs. Sebelius. Naturally, much of the coverage and comments have zeroed in on Chief Justice Roberts’ justification of the individual mandate as a tax rather than as an acceptable form of interstate commerce regulation, which was the main argument offered by proponents of the Patient Protection and Affordable Care Act. Some have claimed that Roberts’ reasoning opens the door for the federal government to tax anything and everything in ways that will allow it to shape citizens’ behavior to a frightening extent. I think that ship has already sailed, though. The principle of an added tax for failing to do something (obtain health insurance, in this case) seems akin to the tax incentives for owning a home or having children. In effect, I was paying higher taxes because I was NOT doing those things in my early adulthood. Little difference, in real terms, between that and the PPACA provision. The government is only forcing people to get health insurance to the same extent they force procreation.

Moreover, this law and this decision represent a compromise that should appeal to both sides of the debate. Since we have made our personal health a commodity to be bought and sold, how can we uphold it as a natural right while still keeping the market “free”? If we have a natural, God-given right to repair and maintain our own bodies, then it exists and deserves protection regardless of our wealth. Nonetheless, when health care is 90% privatized, wealth becomes a pre-requisite for many kinds of care. How do we reconcile this, especially since the price of the actual care is so high that we basically pay it off with a lifetime layaway plan?

Of course, the extremes on both sides are unsatisfied – we don’t have government-provided, free health care for all, nor is the government fully divorced from the free market where most people obtain their care. The PPACA and the Sebelius verdict split the difference in, I think, a decent way:

A.   Insurance companies (the layaway creditors) must keep their doors more fully open. Gotta accept customers with pre-existing conditions, gotta let kids stay on their parents’ plans until age 26. In short, the government has sharply limited the vendors’ power to turn away customers.

B.    To offset this intrusion into the free market, the law expands the potential customer pool by taxing citizens who can buy insurance but choose not to. (The tax does NOT apply to folks fitting one of a couple of low-income criteria – those who couldn’t afford insurance even in the new, open-door stores.) If you believe health care is a natural right, this makes your stomach turn. Why should you be financially encouraged (or, some may say, forced) to buy something if it’s your natural right? To me, it’s a fair trade if you’re also compelling companies to take on the costs of brokering your care and all of your diabetic friends' care.

C.    States are now strongly encouraged to use Federal funds to expand Medicaid. Remember, those who are served by Medicaid are also those that avoid the tax above. These people *need* government-provided health care, and rather than impose a new national system, the current system is expanded. This comes closer to making health care a true natural right; however, it’s still a commodity that even states have to pay for. Originally, the PPACA reduced Federal funding if states refused to take on the additional costs of expansion. The Court today said that was out of bounds. If it’s a joint program, then DC has to play nice with the other states. The belief in health care as a natural right is again balanced against the freedom states have to maintain their status quo.

Some will rightfully ask, what do the uninsured and under-insured do in states that choose not to expand? They holler, they lobby, they sign petitions, they call legislators and governors, they fill message boards and inboxes with cries for that expansion. Or, if possible, they “vote with their feet” and move to a state that offers the expanded Medicaid. They use all the same tools one would use to get Domino’s to improve their pizza recipe or to discourage grocers from selling Oreos. In sum, they use the tools of economic and political democracy; the same ones that brought Obamacare to life in the first place.

Lastly, I have to say that my respect for our Chief Justice grew quite a bit today. He clearly despises the law, and we can almost hear his teeth gnash as he writes this within the judgment’s first hundred words: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.” Amid the divisive firestorm of the sociopolitical debate, Justice Roberts put his personal view of the law aside and strictly addressed the Constitutional issues at hand. Moreover, he addressed those issues rather fairly, balancing our health and our freedoms and the cries from both sides remarkably well. He did exactly what the Chief Justice of the Supreme Court is supposed to do. We could learn from his example today.