Before this week, the well-being of tens of millions of Americans was
at stake in the lawsuits challenging the Affordable Care Act.
Now
something else is at stake, too: The legitimacy of the Supreme
Court.
Nobody knows how the justices will rule. And nobody can know, not
even the justices themselves. On Friday morning, perhaps by the time you read
this, they will meet privately to take their first vote. More often than not,
this first vote determines the final verdict. But there are exceptions and
Anthony Kennedy, on whose decision the outcome presumably depends, has a
reputation for long deliberation and changes of heart—particularly in major
cases like this one.
That’s good. With the result apparently in
doubt—smart money still says the chances of the full law surviving are about
50-50—Kennedy should think long and hard about how he wants the Court to rule.
So should Chief Justice John Roberts, who appeared more skeptical of the
government’s case during oral arguments but nevertheless indicated that he, like
Kennedy, understood the government’s premise—that health care was a special
market, perhaps requiring special intervention.
If that concern is not
enough to sway the chief justice, than perhaps his frequently professed concern
for the court’s respectability will.
Even now, I have trouble wrapping my
mind around what I saw in the courtroom this week and what a majority of the
justices may be contemplating. Kennedy’s second question, the one that so
unnerved supports of the law, was whether the government had “a heavy burden of
justification to show authorization under the Constitution.” But the heavy
burden in this case is on the justices threatening to strike down health care
reform. They have not met it.
Rarely in American history has the Court
struck down laws in decisions that would have such quick, widespread impact. In
the modern era, only two cases come to mind: Brown v. Board of Education and Roe
v. Wade. Both were acts of ambitious, even audacious judicial activism. But, in
two key repsects, they were different from a potential ruling against the
Affordable Care Act.
Brown was a unanimous, nine-to-zero decision. Roe
was a lopsided seven-to-two. These margins mattered: The justices knew that
their decisions would be controversial, in part because they were overruling
democratically elected majorities—in these cases, state legislators who’d passed
laws enforcing segregation and prohibiting abortion. The justices’ authority in
these cases derived, in part, from their moral authority. A closely divided
bench would have made that impossible.
Virtually everybody agrees that a
vote to strike down the Affordable Care Act would be five to four—a bare
majority. And it would be a bare partisan majority, with the five Republican
appointees overruling the four Democratic appointees. The decision would appear
nakedly partisan and utterly devoid of principle. Appearances would not be
deceiving.
The second distinction is even more more significant. Today
Brown is a nearly universal icon of social progress, while Roe remains an object
of great controversy. But, for better or for worse, both cases represented
efforts to change the everyday reality of American life. With Brown, the
justices were tearing down barriers to racial equality; with Roe, the justices
were eliminating laws that prevented access to abortion.
But in this
case, nobody has said they want to stop government from providing universal
access to health care. On the contrary, the plaintiffs have stated that a
program like Medicare, in which the government provides citizens with insurance
directly, would be clearly constitutional. They’ve also stated that a scheme of
compulsory private insurance would be constitutional if somehow the government
could make people buy it when they show up at the hospital—suggesting, as Elena
Kagan stated, that the only problem with the Affordable Care Act is temporal.
Most amazing of all: The plaintiffs have conceded that a universal
health insurance program would be constitutional if, instead of penalizing
people who decline to get insurance, the government enacted a tax and refunded
the money to people who had insurance. As Sonia Sotomayor noted, functionally
such a scheme would be exactly the same as the Affordable Care Act. Both the
plaintiffs and some of the skeptical justices have also indicated that the
Affordable Care Act would be constitutional if the law's architects had simply
used the word "tax" to describe the penalty.
Think about that for a
second: If the justices strike down the Affordable Care Act, they would be
stopping the federal government from pursuing a perfectly constitutional goal
via a perfectly constitutional scheme just because Congress and the Preisdent
didn’t use perfectly constitutional language to describe it. Maybe labels
matter, although case law suggests otherwise. But do they matter enough for the
Court to throw out a law that will provide insurance to 30 million people, shore
up insurance for many more, and help to manage one-sixth of the American
economy? It wouldn’t seem so.
Of course, the conservative justices who
would invalidate the Affordable Care Act may not hold the law in especially high
regard. Samuel Alito, in particular, suggested during oral argument that he had
serious problems with younger, healthier people subsidizing, via their insurance
premiums, the medical expenses of older, sicker people—which just happens to be
the defining feature of Medicare, Social Security, and every other social
insurance scheme on the planet.
Alito is entitled to his opinion about
what makes for good legislation. But he’s not entitled to impose that opinion on
the country and his colleagues aren’t, either. Their job is to determine whether
a law is constitutional, not whether a law is wise. And the more significant the
law, the more unambiguous their judgment ought to be. ++
The
Supreme Court’s Momentous TestNew York Times Editorial
Board
March 27, 2012
http://www.nytimes.com/2012/03/28/opinion/the-supreme-courts-momentous-test.html
In ruling on the constitutionality of requiring most Americans to
obtain health insurance, the Supreme Court faces a central test: whether it will
recognize limits on its own authority to overturn well-founded acts of Congress.
Are the Supreme Court justices giving due consideration to the health
care law, or preparing to engage in “judicial activism” to reduce federal
power?
The skepticism in the questions from the conservative justices
suggests that they have adopted the language and approach of the insurance
mandate’s challengers. But the arguments against the mandate, the core of the
health care reform law, willfully reject both the reality of the national health
care market and established constitutional principles that have been upheld for
generations.
The Obama administration persuasively argues that the
mandate is central to solving the crisis in America’s health care system, which
leaves 50 million people uninsured and accounts for 17.6 percent of the national
economy. The challengers contend that the law is an unlimited — and, therefore,
unconstitutional — use of federal authority to force individuals to buy
insurance, or pay a penalty.
That view wrongly frames the mechanism
created by this law. The insurance mandate is nothing like requiring people to
buy broccoli — a comparison Justice Antonin Scalia suggested in his exasperated
questioning of Solicitor General Donald Verrilli Jr. Congress has no interest in
requiring broccoli purchases because the failure to buy broccoli does not push
that cost onto others in the system.
Congress has indisputable authority
to regulate national markets and provide for the general welfare through its
broad power to tax. Nothing about the mandate falls outside those clearly
delineated powers.
In fact, Justice Scalia has, in the recent past,
declared Congress’s broad authority under the commerce clause to regulate
activities with far less direct economic impact. In a 2005 case upholding a
federal law prohibiting the growing of medical marijuana for personal use, he
wrote that Congress may regulate even intrastate activities “that do not
themselves substantially affect interstate commerce.”
The skepticism of
Chief Justice John Roberts Jr. and Justices Scalia and Samuel Alito Jr. was also
troubling because it seemed to accept an odd distinction of timing made by the
opponents of the law.
Those critics concede that the mandate would be
constitutional if it went into effect at the moment an individual actually
needed health care. In other words, Congress could require the sick and dying to
pay for insurance or for medical services when they show up in the emergency
room, but it cannot require precoverage of medical costs through insurance.
The court has no authority under the Constitution to judge the merits or
effectiveness of the health care law. That is Congress’s job.
Yet, as
Justice Stephen Breyer remarked about the points made by a lawyer for the
opponents: “All that sounds like you’re debating the merits of the bill.” To
counter the challengers’ claims of alarm over a novel policy, he offered several
examples in American history where the court has strongly backed new solutions
to major problems, like the creation of a national bank in the early 19th
century.
If the Supreme Court hews to established law, the only question
it must answer in this case is modest: Did Congress have a rational basis for
concluding that the economic effects of a broken health care system warranted a
national solution? The answer is incontrovertibly yes.
++
Health Care Jujitsu Robert Reich, his blog
via HuffPo
03/26/2012
http://www.huffingtonpost.com/robert-reich/single-payer-health-care_b_1381382.html
Not surprisingly, today's debut Supreme Court argument over the
so-called "individual mandate" requiring everyone to buy health insurance
revolved around epistemological niceties such as the meaning of a "tax," and the
question of whether the issue is ripe for review.
Behind this judicial
foreplay is the brute political fact that if the Court decides the individual
mandate is an unconstitutional extension of federal authority, the entire law
starts unraveling.
But with a bit of political jujitsu, the president
could turn any such defeat into a victory for a single-payer healthcare system
-- Medicare for all.
Here's how.
The dilemma at the heart of the
new law is that it continues to depend on private health insurers, who have to
make a profit or at least pay all their costs including marketing and
advertising.
Yet the only way private insurers can afford to cover
everyone with preexisting health problems, as the new law requires, is to have
every American buy health insurance - including young and healthier people who
are unlikely to rack up large healthcare costs.
This dilemma is the product
of political compromise. You'll remember the Administration couldn't get the
votes for a single-payer system such as Medicare for all. It hardly tried. Not a
single Republican would even agree to a bill giving Americans the option of
buying into it.
But don't expect the Supreme Court to address this dilemma.
It lies buried under an avalanche of constitutional argument.
Those who
are defending the law in Court say the federal government has authority to
compel Americans to buy health insurance under the Commerce Clause of the
Constitution, which gives Washington the power to regulate interstate commerce.
They argue our sprawling health insurance system surely extends beyond an
individual state.
Those who are opposing the law say a requirement that
individuals contract with private insurance companies isn't regulation of
interstate commerce. It's coercion of individuals.
Unhappily for Obama and
the Democrats, most Americans don't seem to like the individual mandate very
much anyway. Many on the political right believe it a threat to individual
liberty. Many on the left object to being required to buy something from a
private company.
The President and the Democrats could have avoided this
dilemma in the first place if they'd insisted on Medicare for all, or at least a
public option.
After all, Social Security and Medicare require every
working American to "buy" them. The purchase happens automatically in the form
of a deduction from everyone's paychecks. But because Social Security and
Medicare are government programs financed by payroll taxes they don't feel like
mandatory purchases.
Americans don't mind mandates in the form of payroll
taxes for Social Security or Medicare. In fact, both programs are so popular
even conservative Republicans were heard to shout "don't take away my Medicare!"
at rallies opposed to the new health care law.
There's no question
payroll taxes are constitutional, because there's no doubt that the federal
government can tax people in order to finance particular public benefits. But
requiring citizens to buy something from a private company is different because
private companies aren't directly accountable to the public. They're accountable
to their owners and their purpose is to maximize profits. What if they
monopolize the market and charge humongous premiums? (Some already seem to be
doing this.)
Even if private health insurers are organized as
not-for-profits, there's still a problem of public accountability. What's to
prevent top executives from being paid small fortunes? (In more than a few cases
this is already happening.)
Moreover, compared to private insurance,
Medicare is a great deal. Its administrative costs are only around 3 percent,
while the administrative costs of private insurers eat up 30 to 40 percent of
premiums. Medicare's costs are even below the 5 percent to 10 percent
administrative costs borne by large companies that self-insure, and under the 11
percent costs of private plans under Medicare Advantage, the current
private-insurance option under Medicare.
So why not Medicare for
all?
Because Republicans have mastered the art of political jujitsu.
Their strategy has been to demonize government and seek to privatize everything
that might otherwise be a public program financed by tax dollars (see Paul
Ryan's plan for turning Medicare into vouchers). Then they go to court and argue
that any mandatory purchase is unconstitutional because it exceeds the
government's authority.
Obama and the Democrats should do the reverse. If
the Supreme Court strikes down the individual mandate in the new health law,
private insurers will swarm Capitol Hill demanding that the law be amended to
remove the requirement that they cover people with pre-existing
conditions.
When this happens, Obama and the Democrats should say they're
willing to remove that requirement - but only if Medicare is available to all,
financed by payroll taxes.
If they did this the public will be behind
them -- as will the Supreme Court. ++
Three days of Supreme Court arguments over the health-care law
demonstrated for all to see that conservative justices are prepared to act as an
alternative legislature, diving deeply into policy details as if they were
members of the Senate Health, Education, Labor and Pensions
Committee.
Senator, excuse me, Justice Samuel Alito quoted Congressional
Budget Office figures on Tuesday to talk about the insurance costs of the young.
On Wednesday, Chief Justice John Roberts sounded like the House whip in
discussing whether parts of the law could stand if other parts fell. He noted
that without various provisions, Congress “wouldn’t have been able to put
together, cobble together, the votes to get it through.” Tell me again, was this
a courtroom or a lobbyist’s office?
It fell to the court’s liberals — the
so-called “judicial activists,” remember? — to remind their conservative
brethren that legislative power is supposed to rest in our government’s elected
branches.
Justice Stephen Breyer noted that some of the issues raised by
opponents of the law were about “the merits of the bill,” a proper concern of
Congress, not the courts. And in arguing for restraint, Justice Sonia Sotomayor
asked what was wrong with leaving as much discretion as possible “in the hands
of the people who should be fixing this, not us.” It was nice to be reminded
that we’re a democracy, not a judicial dictatorship.
The conservative
justices were obsessed with weird hypotheticals. If the federal government could
make you buy health insurance, might it require you to buy broccoli, health club
memberships, cellphones, burial services and cars? All of which have nothing to
do with an uninsured person getting expensive treatment that others — often
taxpayers — have to pay for.
Liberals should learn from this display that
there is no point in catering to today’s hard-line conservatives. The individual
mandate was a conservative idea that President Obama adopted to preserve the
private market in health insurance rather than move toward a
government-financed, single-payer system. What he got back from conservatives
was not gratitude but charges of socialism — for adopting their own
proposal.
The irony is that if the court’s conservatives overthrow the
mandate, they will hasten the arrival of a more government-heavy system. Justice
Anthony Kennedy even hinted that it might be more “honest” if government simply
used “the tax power to raise revenue and to just have a national health service,
single-payer.” Remember those words.
One of the most astonishing
arguments came from Roberts, who spoke with alarm that people would be required
to purchase coverage for issues they might never confront. He specifically cited
“pediatric services” and “maternity services.”
Well, yes, men pay to
cover maternity services while women pay for treating prostate problems. It’s
called health insurance. Would it be better to segregate the insurance market
along gender lines?
The court’s right-wing justices seemed to forget that
the best argument for the individual mandate was made in 1989 by a respected
conservative, the Heritage Foundation’s Stuart Butler.
“If a man is
struck down by a heart attack in the street,” Butler said, “Americans will care
for him whether or not he has insurance. If we find that he has spent his money
on other things rather than insurance, we may be angry but we will not deny him
services — even if that means more prudent citizens end up paying the tab. A
mandate on individuals recognizes this implicit contract.”
Justice
Antonin Scalia seemed to reject the sense of solidarity that Butler embraced.
When Solicitor General Donald Verrilli explained that “we’ve obligated ourselves
so that people get health care,” Scalia replied cooly: “Well, don’t obligate
yourself to that.” Does this mean letting Butler’s uninsured guy
die?
Slate’s Dahlia Lithwick called attention to this exchange and was
eloquent in describing its meaning. “This case isn’t so much about freedom from
government-mandated broccoli or gyms,” Lithwick wrote. “It’s about freedom from
our obligations to one another . . . the freedom to ignore the injured” and to
“walk away from those in peril.”
This is what conservative justices will
do if they strike down or cripple the health-care law. And a court that gave us
Bush v. Gore and Citizens United will prove conclusively that it sees no limits
on its power, no need to defer to those elected to make our laws. A Supreme
Court that is supposed to give us justice will instead deliver ideology.
++
The Supreme Court is so full of it. The entire institution, as well as
its sanctimonious judges themselves, reeks of a time-honored hypocrisy steeped
in the arrogance that justice is served by unaccountable elitism.
My
problem is not with the Republicans who dominate the court questioning the
obviously flawed individual mandate for the purchasing of private-sector health
insurance but rather with their zeal to limit federal power only when it
threatens to help the most vulnerable. The laughter noted in the court
transcription that greeted the prospect of millions of the uninsured suddenly
being deprived of already extended protection under the now threatened law was
unconscionable. The Republican justices seem determined to strike down not only
the mandate but also the entire package of accompanying health care rights
because of the likelihood that, without an individual mandate, tax revenue will
be needed to extend insurance coverage to those who cannot afford it.
The
conservative justices, in their eagerness to reject all of this much needed
reform, offer the deeply cynical justification that a new Congress will easily
come up with a better plan -- despite decades of congressional failure to
address what is arguably the nation's most pressing issue. In their passion to
embarrass this president, the self-proclaimed constitutional purists on the
court went so far as to equate a mandate to obtain health care coverage with an
unconstitutional deprivation of freedom; to make the connection they cited the
spirit of a document that once condoned slavery.
These purists have no
trouble finding in that same sacred text a license for the federal government to
order the young to wage undeclared wars abroad, to gut due process and First
Amendment protections, and embrace torture, rendition and assassination, even of
U.S. citizens.
Now they hide behind the commerce clause of the
Constitution to argue that the federal government cannot regulate health care
coverage because that violates the sacrosanct principle of states' rights. If
the right-wingers on the high court consistently had a narrow interpretation of
federal power over the economy, there would be logic to the position expressed
by the Republican justices during the last three days of questioning. Of course,
the court's apparent majority on this has shown no such consistency and has
intervened aggressively, as did the justices' ideological predecessors, to deny
the states the power to protect consumers, workers and homeowners against the
greed of large corporations.
We would not be in the midst of the most
severe economic meltdown since the Great Depression had the courts not
interpreted the commerce clause as protecting powerful national corporations
from accountability to state governments. Just look at the difficulty that a
coalition of state attorneys general has faced in attempting to hold the largest
banks responsible for their avarice in the housing disaster.
The modern
Supreme Court has allowed the federal government to pre-empt the states' power
to protect homeowners, whose mortgage agreements were traditionally a matter of
local regulation and registration. The court has no problem accepting Congress'
grant of a legal exemption in the Commodity Futures Modernization Act of 2000
that allows the bundling of home mortgages into unregulated derivatives.
The court has vitiated the power of the states to control interest
rates, even though quite a few had explicit provisions in their constitutions
banning usury. The result is that loan-sharking by banks that can claim to be
engaged in interstate commerce is constitutionally protected, which is why there
are no limits on mortgage, credit card or personal loan interest rates.
The sad truth is that President Obama and the Democrats brought this
potential judicial disaster upon themselves. In light of what has been said this
week in the Supreme Court, it seems inevitable that the linchpin of the 2010
reform -- mandated coverage -- will be thrown out, probably along with the
crucial accompanying reforms. Forget coverage for the young and those with
pre-existing medical conditions. The Democrats will protect themselves from this
reversal by arguing that all they did was copy the program that this year's
prospective Republican presidential candidate implemented when he was the
governor of Massachusetts. Mitt Romney's plan included the dreaded mandate that
he and the Republican justices condemn.
How ironic that Barack Obama's
health care agenda would be in a far stronger legal position had the president
stuck by his earlier support of a public option. Clearly, our federal government
has the judicially affirmed power under our Constitution to use public revenues
to provide a needed public service, be it education, national security,
retirement insurance or health care. Obama's health care reform should have
simply extended Medicare and Medicaid coverage to all who wanted and needed it
-- no individual mandate -- while allowing others to opt out for private
insurance coverage. That's an obvious constitutional solution that even those
die-hard Republican justices would have a difficult time overturning.
++
Supreme Court Might Decide Their Second Election
Cenk Uygur, HuffPo
03/29/2012
http://www.huffingtonpost.com/cenk-uygur/supreme-court-health-care-law_b_1387080.html