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Like It or Not, Health Care Mandate Is ConstitutionalPosted on Nov 24, 2009By Ruth Marcus Is Congress going through the ordeal of trying to enact health care reform only to have one of the main pillars—requiring individuals to obtain insurance—declared unconstitutional? An interesting debate for a constitutional law seminar. In the real world, not a big worry. “This issue is not serious,” says Walter Dellinger, acting solicitor general during the Clinton administration. But it’s being taken seriously in some quarters, so it’s worth explaining where the Constitution grants Congress the authority to impose an individual mandate. There are two short answers: the power to regulate interstate commerce and the power to tax. First, the Commerce Clause. Spending on health care consumes 16 percent—and growing—of the gross national product. There is hardly an individual activity with greater effect on commerce than the consumption of health care. If you arrive uninsured at an emergency room, that has ripple effects through the national economy—driving up costs and insurance premiums for everyone. If you choose to go without insurance, that limits the size of the pool of insured individuals and—assuming you are young and healthy—drives up premium costs. Advertisement In the 1942 case Wickard v. Filburn, the justices ruled that even though an activity may “be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce.” Thus, the court said, Congress was entitled to tell Roscoe Filburn how much wheat he could grow to feed his own chickens. Surely, then, Congress could require Filburn’s grandson to buy health insurance. The court has narrowed the reach of the Commerce Clause in recent years—but also reaffirmed Wickard. The times it has found that Congress overstepped involved situations where the connection to interstate commerce was strained: carrying guns near schools or engaging in gender-based violence. In United States v. Lopez, the court found that the Gun-Free School Zones Act “is not an essential part of a larger regulation of economic activity, in which the regulatory scheme could be undercut unless the intrastate activity were regulated.” The individual mandate is “the mirror image of Lopez as a Commerce Clause case,” says Harvard Law School professor Laurence Tribe. Granted, there is a difference between regulating an activity that an individual chooses to engage in and requiring an individual to purchase a good or service. Granted, too, there is a difference between making automobile insurance compulsory, as a condition of the privilege to drive a car, and making health insurance compulsory, whether an individual wants it or not. But the individual mandate is central to the larger effort to reform the insurance market. Congress may not be empowered to order everyone to go shopping to boost the economy. Yet health insurance is so central to health care, and the individual mandate so entwined with the effort to reform the system, that this seems like a different, perhaps unique, case. Congress clearly has authority to, in effect, require employees to purchase health insurance for their old age by imposing a payroll tax to fund Medicare. It’s odd for the same conservatives bemoaning a government takeover of health care to complain about requiring that people turn to the private marketplace. Which brings us to the alternative source of congressional authority, the “Power to lay and collect Taxes, Duties, Imposts and Excises.” The individual mandate is to be administered through the tax code: On their forms, taxpayers will have to submit evidence of adequate insurance or, unless they qualify for a hardship exemption, pay a penalty. Yale Law School professor Jack Balkin likens this to Congress raising money for environmental programs by taxing polluters. “Congress is entitled to raise revenues from persons whose actions specifically contribute to a social problem that Congress seeks to remedy through new government programs,” he concludes. Balkin cites a 1950 Supreme Court case upholding a tax on marijuana distributors. “It is beyond serious question that a tax does not cease to be valid merely because it regulates, discourages, or even definitely deters the activities taxed,” the court said. “The principle applies even though the revenue obtained is obviously negligible, or the revenue purpose of the tax may be secondary.” Sounds like the individual mandate to me. Ruth Marcus’ e-mail address is marcusr(at symbol)washpost.com. © 2009, Washington Post Writers Group Previous item: Age Trumps Youth in UC Tuition Dispute Next item: Still Doing God's Work on Wall Street CommentsAre you a Truthdig member yet? Login now, or register with Truthdig. Add Your Comment |
By ardee, November 28, 2009 at 10:26 am Link to this comment
Anarcissie, November 28 at 1:06 pm
Anyone using Nancy Pelosi as an example of “liberal” contempt for the Constitution has already lost the argument.
Report thisBy Anarcissie, November 28, 2009 at 8:06 am Link to this comment
Ardee—For heaven’s sake, look around. In the present and many other cases, the Constitution is being treated with contempt. When it’s considered at all, then people like Ruth Marcus and whoever writes for Media Matters appeal to pure authoritarianism—“experts” and “constitutional scholars”, not evidence and reason. Read about how Pelosi derided constitutional objections to the “health care” bill. I’ve been discussing this same issue in some other venues and I’ve gotten the same thing. Of course, this attitude is not peculiar to progs. If you want some seriously twisted constitutional logic, try Gonzales v Raich as decided by the right-wing Supreme Court. Of course, the liberals on the Court (if there are any) went along with it. As you noted, the three dissenters included Rehnquist and Thomas, which leaves us with just one sort-of liberal, O’Connor, on the side of the angels.
I have to admit I’m sort of surprised by the depth of the liberal contempt I’ve observed; they usually try to put on a better act. But in fact the present bill is going to be very difficult to justify constitutionally without the kind of absurdities we observe in Gonzales and the cases it depends on. On the other hand, I recognize that Mr. O could not possibly get this bill passed without paying off the insurance companies, and that requires the old gun-to-the-head (to the heads of the working class, that is).
I believe this sort of thing is going to lead to a very unpleasant rectification at some point in the future. Not what I would choose, but apparently the ruling class is going to keep skating on thin ice until it breaks.
Report thisBy ardee, November 28, 2009 at 4:58 am Link to this comment
To make such a statement, that liberals or progressives ( same folks) care not for the Constitution, is simply silly.
It is always the left that points out the Constitutional violations of the right, demands investigation and prosecution for those , like Alberto and Dickie and defends that document as a living breathing and vibrant guide to our democratic process.
Report thisBy No_Man's_Land, November 27, 2009 at 9:57 pm Link to this comment
Arnicissie:
You’re probably right on that. The echo chamber of the left wants a political win and will claim a convoluted constitutionality to have it whether its a working solution or not. However, I’ve also seen Democracy Now and a couple others point out some of the things you’ve mentioned, mainly in the “gift to big business” vein. I suppose it shows once more that there is no difference between the two parties. I do think its helpful to distinguish between partisans and progressives/conservatives, though. The former is a foot soldier and the latter tends to be more independently minded in my opinion.
The irony: Obama ran on a platform of uniting the nation and he just might do that with progressive and conservative opposition to this bill.
Report thisBy Anarcissie, November 27, 2009 at 10:17 am Link to this comment
It’s not entirely, 100% fair, but it seems to be about 90% true, or “true enough”. I should add, of course, the most “conservatives” and “moderates” have also stopped caring about the Constitution. Media Matters, a liberal Democratic web site some of you are probably familiar with, brought the issue up and gave the most specious grounds for the Constitutionality of the present bill, mostly authoritarian references to “Constitutional scholars”, and when several commenters pointed out how illogical they were they stopped updating the comments. Like Ruth Marcus’s article, this seems to be the typical way of dealing with the issue: power first, power last, power always, forget the rules we supposedly agreed to.
Report thisBy Jim Yell, November 27, 2009 at 8:22 am Link to this comment
(Unregistered commenter)
First let’s stop hyper-ventilating. Yes, the private insurance industry had lied, cheated and doesn’t deserve to survive, but if the majority sit on their hands in this matter we shall be forced to pay huge insurance premiums to for profits, who have shown a complete lack of care about their subscribers and inspite of promises privitize doesn’t bring lower prices, without regulations and rules.
For National Healthcare to succeed it requires everyone pays their share, but as that is everyone, it should make the premiums very low, unless the government would use it for creating over paid executives or suffocating administration. Still looking at the mess of private insurance does anyone really believe it would be worse than what the pirates in the for private insurance industry is doing to us right now?
Virtually no one in the country would not be “better off” if we had National Healthcare. The workers in the private insurance industry would find a better employer in the government than the vampires in Insurance industry and so would the subscribers.
The only thing to get mad about is mandating we surrender our paychecks and income to these cheats and liars who have so many years created this financial ruin thru private health care.
Report thisBy No_Man's_Land, November 27, 2009 at 8:11 am Link to this comment
Arnicissie:
“The Constitution to some extent was supposed to protect us from unlimited governmental power like the above, but liberals and progs don’t care about the Constitution any more. As witness the article that begins this discussion.”
I’m not sure that’s an entirely fair statement. I think a lot progressives and conservatives alike are concerned about individual mandates to the insurance industry. I can’t think of any product we are required to purchase carte blanche as we are about to have happen. Personally, I think extrapolating the right to regulate comerce and to levy taxes to private purchase requirements is quite a stretch and most likely just legal spin. A private purchase requirement is not a tax. That money is not returned to the population in the form of benefit. Nor does it do anything to regulate an industry. If anything, it removes any incentive of the industry to self-regulate. They will become Toll Trolls all the more.
I think, or at least I hope, what we are seeing is something of an an awakening to the corporate aristocracy we have become, or as Chris Hedges puts it, “Neo-Feudalism.” Either way, we are witnessing the fusion of government and corporate power to an extent we have not seen before. I think we can expect more of this in the future.
Report thisBy Anarcissie, November 26, 2009 at 7:20 am Link to this comment
A lot of people simply can’t afford to have medical insurance, and a lot of people choose not to. In many cases there is something of a trade-off between one expense and another. Forced payments to insurance companies will have to come out of some other part of the family budget, like perhaps the part that pays for nutritious food, warm clothing, or decent housing; thus, more people will get sick and the medical industry will make even more money. The insurance payments themselves will go to the wealthy profiteers of medical insurance. Those who can’t pay can get down on their knees in front of social workers and beg for Welfare, which means having their whole private lives exposed to and judged by petty bureaucrats. The extra expense will be borne by their neighbors, because it’s the working people, and only the working people, who pay taxes. It’s not a pretty picture.
The Constitution to some extent was supposed to protect us from unlimited governmental power like the above, but liberals and progs don’t care about the Constitution any more. As witness the article that begins this discussion.
Report thisBy tommym, November 26, 2009 at 4:50 am Link to this comment
Ummmm, For the most part i would have to assume that people dont have health insurance because they cannot afford it, not because they CHOOSE not to have it. This health care debate and all of its accompanying nonsense has really thrown people off course. My wife and i used to live in vermont and it would have cost me so much to obtain health insurance that i would not have beenable to pay my bills, so put back in that same position i cant see that a government mandate for me to have health insurance under threat of penelty would help to solve the problem, actually it would have put me in the poor house. The reason we are having this debate is because there is a fundamental flaw with our healthcare system, not the people who use it.
Report thisBy julie d'oceanie, November 25, 2009 at 8:52 pm Link to this comment
(Unregistered commenter)
What the law will require is for a person to sit down and sign a contract with a company to buy a product. I know this is unprecedented, because it has never happened to me before that the government has said to me: buy this or pay a fine.
The analogies with car insurance don’t work. The government doesn’t require you to buy a car, just to buy insurance if you drive one. Perfectly reasonable.
But to be forced to buy something just because you’re alive? Unprecedented. Unconstitutional.
Coercion. Coerced contracts are unenforceable.
I would feel differently if everyone were required to get insurance from a common, non-profit pool.
But to require me to do business with for-profit insurance companies, who have shown themselves many times to be crooks, is extremely offensive. I don’t care what Laurence Tribe says.
And what does he care anyway? No one is going to force him to buy a crappy product, since Harvard U, I’m sure, gives him very nice health insurance, practically for free, since he knows so much about the Constitution and all. Screw him.
And, by the way, these congress people, don’t they get free health insurance, too? Courtesy of us? I would like what they’ve got.
Report thisBy cyrena, November 25, 2009 at 6:42 pm Link to this comment
“…Health insurance is NOT central to health care as the single-payer systems
around the world prove and as the millions of people who do not have it prove.”
This is an incredibly stupid statement, even for you tropic girl. When people don’t have insurance, they don’t get health care, and they subsequently die as a result. We KNOW this, and the stats are all over the place, and have been for decades. So, how to you figure that health insurance is NOT central to health care, for that 99% of the population who are NOT holding 90% of the wealth? And who exactly do you think is providing the funds for the so-called single-payer systems around the world. WHO are these ‘single payers’?
Answer: TAXPAYERS!!!
I keep hearing all of these repugnant republicans claiming a ‘government’ takeover of the health care system, and the same morons are claiming that we should have a ‘single payer’ system like some of the other countries in the world. In those systems, WHO is providing the healthcare?
Answer: The STATE! They are government operated health care systems.
Auto insurance wasn’t central to driving a car (at least in California) until maybe 2 decades ago. When I first started driving, the ‘law’ required that one either have auto insurance OR show proof of enough money (in the form of a bond) to cover up to something like $120,000.00 of coverage to the injured party, and that was 40 years ago. Can you imagine what that would be now? (nevermind, the bond alternative is no longer applicable - everybody has to have insurance to drive a vehicle).
So, how many Americans do YOU know who can just whip out the checkbook to cover that cancer treatment or any other killer disease, or even a cesarean section delivery for that matter? I mean come on. How many people don’t know that 90% of individual bankruptcies in the US are a result of health care expenses?
Now from the article..
“Balkin cites a 1950 Supreme Court case upholding a tax on marijuana distributors.”
THIS startled me, seeing as how I never knew there were marijuana distributors back in 1950. What a hoot. As far as I know, they still aren’t charging taxes on marijuana in the states where it is legal, and THAT tax would sure as hell provide a goodly portion of the revenue required to provide health care to all. It’s the biggest cash crop the US has.
Report thisBy chch, November 25, 2009 at 5:40 pm Link to this comment
(Unregistered commenter)
I just have to comment on the whole “it’s like auto insurance” analogy. In my state, I do not have to insure my car—I am free to accept any loss to myself. I must insure my vehicle for the damage I might do to others—i.e. liability—which is only just. And no one forces me to drive.
I’m as left-wing as you can get and I am eager to volunteer for a class action filing against being coerced to purchase insurance—tax me for universal access to full-service health care (i.e. not just medical) or leave me alone.
Report thisBy Woody, November 25, 2009 at 2:33 pm Link to this comment
(Unregistered commenter)
Having a car is pretty important to commerce, too. Why not, then, have the law also require every citizen to buy one of those, too? The Health Care Bill as it stands is a stealth national stimulus package, and bail-out for the insurance industry; it all should be renamed, “Health Insurance Care Bill”.
Report thisBy Anarcissie, November 25, 2009 at 2:23 pm Link to this comment
Single-payer is certainly more constitutional than the present offering—in reason. But as I’ve pointed out, reason doesn’t matter.
Report thisBy Anarcissie, November 25, 2009 at 12:34 pm Link to this comment
We certainly don’t have to abolish the Constitution. Clearly, it has already been abolished, to whatever extent it has become inconvenient for our lords and masters.
This is a problem only for those who think the idea of limiting the powers of the government is a good thing. It appears that they are a small minority of the population. Most conservatives, liberals, progs agree that quibbling about whether something is constitutional or not is ridiculous, as long as what’s happening is part of the program of their particular team.
However, I do wish the purveyors of arbitrary and total state power would not bother with silly, illogical pretenses at constitutional justification such as the article we’re commenting on. That’s not because I think they carry any political weight, it’s just literary criticism. If Gonzales v Raich, as given by the Supreme Court, is valid, anything is valid—logical gyrations and contortions are unnecessary—and that’s the end of the story.
Report thisBy tropicgirl, November 25, 2009 at 12:12 pm Link to this comment
(Unregistered commenter)
Thanks for giving us your “best answers” to the charges. Is that all you have to
defend mandates? Really?
Health insurance has NO effect on interstate commerce. That is what some
people think is part of the problem, they do not sell across state lines,
remember?
Health insurance is NOT central to health care as the single-payer systems
around the world prove and as the millions of people who do not have it prove.
If the congress can tax the people who are “causing the problem”, then they
will have to restrict their tax on the chronically sick, disabled children and
others. Nice going. And there is NO precedent for turning this tax money over
to a private crooked company. This money would have to go for government
single payer.
This is NOT like car insurance. Car insurance is the price of couch change.
Health insurance the price of a mortgage.
You have a better chance of getting taxes from marijuana distributors. And, if
you hold to the argument here, the insurance companies are the ones that
should be paying any tax.
If a novice like myself can debunk this crap in a few minutes, what makes you
think anyone else is buying it?
All else, look forward to a legal argument that will last until your journalism
career is in its sunset.
The only solution here is government-run single payer. And arguments like
Report thisthese continue to prove it.
By Night-Gaunt, November 25, 2009 at 9:40 am Link to this comment
“The clause empowers Congress “to regulate commerce ... among the several states,” which may not sound terribly sweeping. But since the New Deal, the Supreme Court has interpreted this authority to cover local activities with national implications.”
Precisely what is used for our ongoing Drug War (some of ) and the idea of a Tax on illegal substances was overturned because it is ridiculous to tax something while it is illegal.
However we need medical coverage for everybody. Not the forced insurance coverage they want where we can be fined and even put in jail if we can’t pay. That is evil. That is state tyranny in service to the corporation and that could easily be identified as fascism and that is a poison in our system of gov’t. A contagion that needs to be eradicated now and forever or else it will overwhelm and kill the republic of which it infects. The patient is in the ICU and the code blue has been averted but nothing else. Another code blue is imminent.
Report thisBy politiciansRvampires, November 25, 2009 at 8:35 am Link to this comment
(Unregistered commenter)
Marcus probably couldn’t begin to understand the plight of someone laid off and down to counting pennies having to decide whether to pay the light bill or the New Mandatory Insurance Premium.
She’s got hers, all her friends drive new cars and life is grand.
So what if the constitution is bent a little, her side won.
Well one could hope that Marcus kids hit the skids, and get force fed a little bit of how the other side lives. That’s the only good thing about this mandatory crap, some of the cheerleaders are going to find it’s not all it’s cracked up to be.
And the oath that’s taken to uphold the Constitution? If the people ever get smart they’ll see that it’s not ignored, or maybe it’s over the heads of the masses. Who could blame them.
Oh and one last thing, Marcus: Don’t you even think of whining when the next Republican mandates you purchase something. Don’t do it. Ya Hear?
Report thisBy ardee, November 25, 2009 at 8:34 am Link to this comment
Dissenting from that ruling were Justices O’Connor, Rehnquist and, strangely enough, Thomas.
But the point of the matter is not that, because of such a ruling we need to abolish the Supreme Court, but that we need to understand that the law is a living entity, as is the Constitution, and to hold that because mistakes are made we should simply abolish that body is childish indeed.
Inevitably, as our society and our culture changes, our governing bodies sometimes lag behind the curve, and sometimes, as in our present situation, desperately need reforming, not abolition with no plan or scheme as to what will replace it.
Report thisBy tommy, November 25, 2009 at 8:08 am Link to this comment
(Unregistered commenter)
Typical party hack BS. Here’s the commerce clause: “To regulate commerce with foreign nations, and among the several states, and with the Indian Tribes;”.
Report thisSo exactly where does it say they can regulate because it “affects” commerce? It DOES NOT. Never has. Read the BS supreme court opinions. The reason they are 100 pages plus is because they want you to be so exhausted by the time you finish reading that you don’t realize they make no sense. There is no logic to them. You can’t get from point a to point c via point b.
If health care practitioners or insurers are state entities, operating within ONE state, there is no “commerce among the SEVERAL STATES”, and no amount of perversion of the english language can create it. Medical licenses are issued by the STATES, not the US government. They are no good outside of that SINGLE STATE. There is no interstate commerce involved.
This clause has been so abused by the party hacks on the federal bench that now we have virtually any human behavior illegal under federal law. Where has this gotten us? The dollar is almost ruined. We manufacture very little in the US now, thanks to SS, Medicare, and other exponentially increasing costs associated with any fedeal benefit program.
We are now number one in the world in only 3 things: Arms manufacture; debt, both personal and national; and locking up our citizens. With this and other programs, we’ll soon also be number one in unemployment.
By thekingofcheap, November 25, 2009 at 7:49 am Link to this comment
(Unregistered commenter)
Sorry, but I fail to see how forcing citizens to buy a product in order to maintain legal good-standing is Constitutional.
The American colonists revolted because England forced them to buy certain products over which the mercantilist government maintained a monopoly. This would be no different.
If this bill passes with a mandate included, I’m leaving this country ASAP. I am uninsured and have NO INTEREST in ever buying insurance again after my previous experiences.
Report thisBy Anarcissie, November 25, 2009 at 6:48 am Link to this comment
I have raised the constitutional issue myself in some other venues, mostly out of curiosity. The consensus seems to be that the Supreme Court can do anything it wants, even if the conclusion is absurd. Thus, in Gonzales v Raich, the Supreme Court held that Congress could, under the interstate commerce power, prohibit a person from growing marijuana in her own house strictly for her own use. There is no reasonable way of twisting the Constitution to that extent, but the Supreme Court did it, and it’s settled law.
The constitutionally unusual thing about Congress’s present “health care” bill is that it mandates payments by private citizens, who may not be engaged in any kind of commerce at all, much less interstate commerce, to other private citizens (the instuance companies). It is not a tax, which the Constitution certainly legitimates, but a taking from one person for the benefit of others, a power which the Constitution clearly does not give the Federal government.
But such considerations will not bother the Supreme Court. This does not mean it will necessarily find a particular version of the bill constitutional; it means that the Court will follow its own calculus of political power regardless of the Constitution. If it thinks this bailout of the insurance companies, as Kucinich called it, is what the preponderance of ruling-class power favors, it will hold it to be constitutional. If not, then not.
Not to worry about the Constitution, then—the Constitution, as Alberto Gonzales understood, is a scrap of paper. Like the Geneva Convention it, too, is “quaint”—and evidently dead. Worshipers of state power, like Ruth Marcus, can rejoice.
Report thisBy ardee, November 25, 2009 at 4:32 am Link to this comment
If health care is a right then our govt would be obligated to provide such care to promote the general welfare. To ensure the profitability of the Insurance Industry seems a shoddy motive to me.
Report thisBy Miko, November 25, 2009 at 3:48 am Link to this comment
(Unregistered commenter)
Wickard v. Filburn was decided incorrectly. By the same logic, the government could (following in the footsteps of a certain South American folly) ban the collection of rainwater and give one or more well-connected companies a monopoly right to sell water at exploitation prices. Replace water with health insurance and you end up with a fairly accurate description of what Congress is doing now.
“these guys don’t even care as they have socialized medicine for themselves”
Their health plan is based on having people who aren’t them pay for it. If you try and do that for everyone, you’ll quickly run into the problem that their are no longer any more people outside of the plan to pay for it.
Report thisBy FRTothus, November 25, 2009 at 2:47 am Link to this comment
Reduce everything to dollars. Socialize all costs… privatize all profits. Stolen fair and square and according the whore called law.
“Laws: We know what they are, and what they are worth! They are spider webs for the rich and mighty, steel chains for the poor and weak, fishing nets in the hands of the government.”
(Pierre-Joseph Proudhon)
“Never forget that everything Hitler did in Germany was legal.”
Report this(Martin Luther King, Jr.)
By amex, November 24, 2009 at 11:29 pm Link to this comment
I’m so sick and tired of lawyers and politicians I could puke! They throw constitutionality out there as if it’s precious and so American when it suits their corporate filthy greed, and tell the same people that parts are not necessary when they want to fuck over whatever part of the world they are choosing at that moment.
I say - screw mandatory insurance when insurance companies have done nothing in the past to honor insurance coverage. The second you tell me “for profit”, I tell you “no paying out claims” it is that simple!!!!! You can’t get these filthy maggot politicians to even talk of their social insurance or what is a reasonable cost for us to pay.
I simply can’t understand all of these people out doing the bidding for insurance companies, many that don’t have any insurance, while saying no to a different “not for profit” health scheme.
The USA stinks with health care - I know for a fact what health care is like in several countries and even have my health care in a different country. I don’t give a rats ass what your idiot politician is telling you about other methods - these guys don’t even care as they have socialized medicine for themselves.
Report thisWake up Amerika!!!!!