Healthcare and Constitutional Flexibility
By Taylor Marvin
Within the next few years it seems likely that the Supreme Court will hear a case challenging the constitutionality of the individual mandate portion of the Affordable Care Act. The actual legality of such a case are debatable- while the mandate is a departure from previous federal policy it isn’t unprecedented and the federal government’s argument that its constitutional right to regulate interstate commerce permits requiring individual citizens to purchase insurance seems convincing. But these legal challenges raise an interesting question: what will it mean for the United States if ACA is struck down?
Individual mandates are not a perfect policy- there are real problems with requiring citizens to purchase insurance or be provided with it be their employers, and conservatives are right to raise these concerns. However, it’s clear that some form of mandatory insurance scheme is necessary to the long term success of the Unites States. Healthcare costs are growing four time faster than wages, and is already one sixth of GDP. Simply put, this is not sustainable. Healthcare costs are the primary drive behind the growth of the national debt and if the federal government continues it’s current approach to healthcare policy the United States will economically fail. Some form of rationed government insurance program is probably necessary to preserve the long-term fiscal solvency of the United States. This is the grim inescapable fact of the healthcare debate- when critics of healthcare rationing say that it’s immoral to limit end of life care because it puts a price on human lives they’re not being honest. Caring for people and keeping them alive does have a real financial cost, costs that the government often ends up footing the bill for. If we reject healthcare rationing then we are basically writing a blank check that our society has no hope of ever making good on. This isn’t responsible or intellectually honest- pretending that healthcare doesn’t follow the normal rules of accounting fundamentally doesn’t make sense. Either we restrict the public obligation to healthcare or the debt will continue to rise, it’s that simple.
However, there is a way out. Every other developed nation spend much, much less than the US on healthcare and consistently see better overall results. While the design of these programs vary, most include some type of government run insurance program that formally limits costs. However, if the US Supreme Court eventually rules that ACA is unconstitutional it would cast grave doubts on whether America could ever move towards this type of system.
If this does happen it raises a problem. America needs to radically reform its healthcare system- this is a basic issue of our long-term fiscal survival. As long as some portion of the population doesn’t have health insurance, whether because they’re poor and can’t afford it or young and healthy enough to decide to take their chances, some of the uninsured will get sick or hurt and come into emergency rooms. As long as our society isn’t prepared to let the poor and uninsured die without treatment the government will have to subsidize this cost. However, if insurance mandates are ruled unconstitutional it would probably shut the door to this type of national health policy for decades. If conservative opponents of ACA aren’t able to quickly implement another, presumably constitution plan, to control healthcare costs the future of this country’s fiscal solvency is in real jeopardy.
If the United States is constitutionally prevented from moving toward the type of healthcare system the rest of the rich world has successfully adopted then we have a serious problem. While the Constitution is and should remain the final word regarding the general role of American government and the sanctity of individual rights it isn’t prepared to settle this type of debate. The Constitution was written in a time without any type of government heath obligation, without the complexities of modern medical care and without any notion of a public social safety net and we should interpret it as such. It’s worth acknowledging that while the constitution is probably one of the most important forces in shaping America’s stability and prosperity it does mandate a government structure that isn’t entirely optimal. The Senate gives massive legislative overrepresentation to a small portion of the population and disenfranchises urban, populous states and the electoral college is pretty unjustifiably undemocratic. Were the Constitution written today the compromises that gave birth to these features would probably have been left out- they’re a product of their time, not their utility. We should be honest in recognizing that there are parts of the constitution that make our nation profoundly uncompetitive in the modern world. Our inability to repeal wasteful government subsidies, to cut federal spending or even repeal any significant federal program are all a result of a constitution that wasn’t written to address these problems. Normally this wouldn’t be an issue- the Framers wisely designed an amendment process intended to allow the Constitution to stay relevant through changing times and a court system with the power to allow broad public opinion to determine its interpretation. But while the amendment process was designed to be slow and difficult and require deep public support for any Constitutional changes the modern partisan political climate probably makes any significant amendment impossible for the conceivable future- the last Constitutional amendment to attract any meaningful controversy was passed during the 1960’s. If the individual mandate is ruled unconstitutional it should be a wake up call: if our current interpretation of the Constitution forbids America from adopting a governing strategy the rest of the developed world has successfully used for decades maybe the policy isn’t the problem, our own attitudes are. Our governing philosophy isn’t perfect, nothing is. Recognizing that we should be open to ideas from the rest of the world is vital to our long-term competitiveness as a nation. If an unchanging interpretation of a static document doesn’t encourage this flexibility the Unites States may be in a lot more trouble than we recognize.