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Jedediah Purdy

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How to Read the Health Care Opinion

Posted: 06/28/2012 2:01 pm

Law happens on a field of pain and death. For all their dry distinctions and sonorous tone, judges' opinions set people free and send them to die, grant them security or leave them deprived.

This was acutely true when the Supreme Court ruled on the Affordable Care Act, the most important piece of social legislation in perhaps two generations. The ACA is flawed, but it moves tens of millions of people from insecurity toward reliable care. It also makes our crazy system of funding health care somewhat more rational. Striking it down would have been the most egregious piece of judicial politics since the Supreme Court went to war against FDR's New Deal -- and lost -- in the mid-1930's.

Anyone who cares about fairness and good sense in social policy, then, should count today a victory -- as most progressives are doing.

At the same time, we should be clear on this: our relief is much too close to "Thank God he didn't hit me." The Supreme Court, on its own previously announced principles, had no business coming so close to invalidating the ACA.

Justice Roberts's opinion makes him a hero for a day to many liberals. It also moves the Court, at a stately pace, toward an aggressively right-wing view of the federal government's power. Moreover, it keeps the Court at the very heart of issues where it does not belong. For all its obvious appeal, it is self-aggrandizing and far more radical in its reasoning than in its outcome. That reasoning may have serious consequences down the road.

Roberts accepted that Congress cannot require individuals to purchase health insurance under its power to regulate commerce among the states. The power to regulate commerce, he argued, does not extend to the power to mandate purchases. On his logic, if Congress had this power, it could require people to buy cars or healthy food -- the infamous broccoli example.

This may not matter much in practice, because Roberts upheld the requirement to purchase insurance under the separate Congressional power to tax, by interpreting as taxation the fee for not purchasing health care. It is very hard to imagine a law Congress would ever want to pass that could not survive this scrutiny. Therefore, the ruling on the Commerce power may be mainly symbolic. For nearly 20 years, the Court's conservatives have insisted on limits to the Commerce power while not doing much of consequence with those limits. This opinion may be another of those rhetorical rulings.

That said, consider the way the Roberts opinion envisions the world. We are governed by politicians who want to force us into gym memberships and stuff broccoli in our faces. The democratic process is not enough to protect us from such palpably unpopular laws. We need the Supreme Court, wielding the Constitution, to protect our liberty to spend our money where we like, and not elsewhere.

To accept that these are urgent constitutional concerns, you need a very mistrustful sense of government. You also need to see consumer liberty as a touchstone of American freedom. For almost eighty years, constitutional law has assumed that Congress and state legislatures can be trusted to make economic judgments (better trusted than courts, anyway) under democratic scrutiny, and that individual economic freedom is not a constitutional liberty. To be swayed by the Roberts opinion, you need to squint at the world in quite the opposite way.

Purely as a country boy from West Virginia, I am libertarian enough to like the idea that Congress can't make me buy things from corporations. As a student of constitutional law, though, I am obliged to say that Roberts's argument has force only in a Tea Party view of government and personal liberty, and that the opinion's rhetorical embrace of Tea Party constitutionalism should worry people who think complex problems like health care unavoidably require complex -- and politically possible -- solutions. Congress adopted the individual mandate to deal the insurance companies into the political bargain, as conservative reformers had long urged. If not for the saving thread of the taxing power, Roberts's opinion would have left no solution to the health-care crisis that was both politically viable and constitutionally permitted. To repeat, the Court had no business coming so close to gutting the law, and the fact that it did so, and is being celebrated for withholding the knife, is a mark of how far the public has accepted aggressive judicial review of legislation that should not be constitutionally suspect.

The other major part of the Roberts opinion held that the federal government cannot withhold Medicaid funds from states as a punishment for failing to adopt the ACA's expansion of Medicaid eligibility to 133% of the federal poverty line. Roberts argued that the threat to withdraw Medicaid funding is "a gun to the head" that impermissibly coerces the states. The idea is that the federal government cannot directly tell the states which laws to pass, and giving them an offer they cannot afford to refuse amounts to dictating their Medicaid legislation.

For many decades, Congress has been influencing state legislation with fiscal carrots and sticks -- offering money to fund policies it likes, withholding funds when states don't pass desired laws. If you wonder why every state sets the drinking age at 21, it's because they would lose federal highway funds if they set it lower. The Court has previously made a few muted noises about possible limits to this use of Congress's "spending power" to influence states, but this is the first time it has actually set a limit to that power. This is a new, and potentially big, roadblock to federal policy-setting. It intercedes the Court between Congress and the states and guarantees future challenges to spending legislation. How much it will matter to the ACA's anti-poverty effect depends on how many states will simply refuse to expand Medicaid, now that they know they can't lose their existing funding for doing so. The number may be quite large, which means more people without health coverage and more people crossing state lines in search of more generous care -- never a good solution, and a large part of the reason Congress aimed for uniformity.

Bottom line: Justice Roberts saved the constitutionality of a humane and centrist piece of social legislation. Gutting it would have been radical, and it is astonishing that four justices would have done so. (I'll post later on the dissents.) He also confirmed the view of the Constitution that made the attack on that law seem plausible. That constitutional view is itself radical. It affirms that the Court belongs at the heart of this issue, and guarantees its future role in similar controversies. Progressives should not be grateful for this.

Every law student learns, on the first day of constitutional law, a brilliant victory that Chief Justice John Marshall achieved in the touchstone case of Marbury v. Madison. While giving his opponents what they wanted -- declining to award a federal patronage position to one of his fellow Federalists -- he announced the Supreme Court's power to invalidate federal legislation on constitutional grounds. He hugely expanded the Court's power, moved it in the direction of his constitutional vision, and did so in a case where those most likely to oppose him were mollified by the result.

John Roberts was an outstanding law student. He has not forgotten his early lessons. The rest of us should not forget them, either.

 
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12:34 PM on 06/29/2012
Here is how I read it. The original Obamacare legislation called for the payment mechanism to be a tax. The Democrats indicated that they did not want a tax so they change it to an individual mandate with a penalty (that cannot be enforced by the IRS). Obama (a constitutional scholar), Reid, Pelosi, the Democratic Chairman of the Senate Finance Committee, Sibelius, the Secratary of HEW as well as most Democrats who voted for Obamacare are on record stating that it was NOT a tax. Obama is on record stating that he would not raise taxes on the middle class (those earning less than $250,000 per year). As soon as Obamacare was challenged and taken to court, the government did an about face and called it a tax. The American people were lied to. Vote the liars out of office in November.
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NotNixon
I'm an orangutan with a penchant for Pall Mall
05:07 PM on 07/02/2012
Who's "the government", chief? The Supreme Court - a different branch - decided that it fell under the power to tax imparted to the federal government. They also decided that the Medicaid expansion...wasn't part of Medicaid. Because they felt like it.

No one did an "about face". The Supreme Court just did what they usually do: whatever they want, regardless of who it affects and what specious reasoning they use to fulfill their political dreams. Would you like us to magically vote out the Supreme Court?
11:45 AM on 06/29/2012
As someone on the other side I'm confused by the progressives here expressing dismay about the idea of the court system being used to "make policy." I thought that was has been a de rigeur strategy since at least Roe v. Wade has it not? And what's so shocking about the Court deciding constitutional validity of a law? That's radical? I don't understand the issue here. I keep here "duly passed law" - many duly laws are unconstitutional, isn't that what the courts are supposed to protect against?
10:16 AM on 06/29/2012
When the ruling came down, libs were praising Roberts while he was shanking them in the liver. Hilarious!
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henryberry
MASSACRE IN NEWTOWN Adam Lanza Passage to Madness
09:05 AM on 06/29/2012
Chief Justice Roberts does Obamacare no favor by his reasoning allowing it to stand. In his legalistic sleight-of-hand (e. g. , relabeling the penalty as in effect a tax), he critiques Obamacare from a conservative perspective. Roberts sees Obamacare as another costly burden foisted on Americans by an outsized Federal government; and he limits Obamacare by ruling that state's do not have to go along with it. Roberts remark that it is not the Court's job to "protect the people from the consequences of their political choices" is pointing out to those mistakenly believing he favors Obamacare that they (mostly liberals and progressives) will get what they deserve. 
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ClarcKing
Citizen
10:16 AM on 06/29/2012
Chief Justice Roberts remarks are the most damaging to the ACA legislation which should never have gone past the lower house to begin with. Both Congress and Courts are communicating to the American people a very nasty, ominous profession, " We do not serve the citizenry", However they do serve, we just like to know who and why?
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henryberry
MASSACRE IN NEWTOWN Adam Lanza Passage to Madness
12:53 PM on 06/29/2012
I'm not sure which way you're going in your brief, though to-the-point remark. However: I'm not seeing that many are detecting the sarcasm--along with supreme presumptiveness--in Robert's ruling(s) and his remark about not protecting people from the politics they have chosen. The health-care law is now Roberts's health-care law, not Obama's.
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ckdogs
Veritas
08:52 AM on 06/29/2012
Interesting and sad. I agree that the Court should not have had a say in this. There is something wrong when a duly passed law that positively affects everyone in the country can be brought down by one person. And I still wonder if this wasn't a political decision based on the Court's low standing because of its' other unpopular decisions. On the other hand - when did Republicans care about public opinion?
Their agenda comes first.
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ClarcKing
Citizen
10:07 AM on 06/29/2012
The ACA was always a bailout for the Insurance Industry. The crisis within the bankrupt Fed enforced, monetary financial, bailout system, forced this oppression through sophistry upon the citizenry. The Supreme Court should have said so. Roberts remarks are cause for concern and repeal of the ACA; did he just expand the taxing powers? Congress and the Courts state that Americans do not have economic rights, and now restricts access to medical services, with the State and Federal governments at odds with each other. Congress has completely abandoned its mandate to elevate the population's standard of living, and serves the private sector, 'allowing it to blossom', according to Senator McConnell. The decision furthers the 'save the banks, kill the people' policy. The Courts, according to Roberts, have no right to intervene. Irrationalism reigns supreme.
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08:20 AM on 06/29/2012
Thank you for this post. You've articulated a concern that I had when I heard the decision. My gut was saying "be careful what you wish for ..." The fact that there really IS no real penalty if you don't get health insurance and the states are given an out on the Medicaid part, the law is not even as strong as what was signed into law, even without the future attacks we can expect from the right.
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08:18 AM on 06/29/2012
How to read the health care opinion: -Locate your W-2
-Go to box 4
-"Read" contents
This applies to working taxpayers only.
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wwilcox
Laws are made by people, not gods.
07:06 AM on 06/29/2012
When I was growing up, I learned that the SCOTUS was the final, impartial, arbiter in our system of checks and balances. And it was- then. This poster is correct; it should never have come so close. And only to be decided by one fence jumper, John Roberts.

I could provide a dissertation on how the Reformation changed law, and the appearance of law, in the western world, but who would care?
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08:12 AM on 06/29/2012
It's pretty evident now that the Left judges and Roberts "changed law" when they modified the Governments case to clear the judicial bar. Nothing like having a judge help you develope your arguement to ensure that it is upheld. All should care.
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wwilcox
Laws are made by people, not gods.
09:23 AM on 06/29/2012
I sorta agree with you. At least in respect to the height of the judicial bar. How far did they jump for Citizens United?

Oh, and they did not "change law". They upheld law.
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wwilcox
Laws are made by people, not gods.
09:25 AM on 06/29/2012
P.S. Get a new avatar, that one is juvenile.
05:26 AM on 06/29/2012
Exactly. Brilliantly explicated. Thank you.
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istanbulite
04:17 AM on 06/29/2012
ACA was developed by Obama and the Congress by compromising with the Insurance industry and elected officials. It used Romney's Mass. plan as a foundation. We would have been far better off with a universal plan that merely expanded Medicare for all buyers. That plan would have been unassailable in a constitutional capacity. While Roberts is conservative, he is not nuts like Scalia and Thomas. He also has a preexisting condition of epilepsy. For those who doubt the power of that issue, try living with epilepsy without the benefit of insurance. He never knows when a seizure might happen and how his head and body might hit any solid object. There for the grace of god go I.
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08:20 AM on 06/29/2012
I totally agree...thanks for you post.
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istanbulite
09:53 AM on 06/29/2012
Thanks NMF.  Lots of positive responses but a couple of negs who think it is nuts to highlight  Robert's health situation.  Clearly they have no idea what it is like to worry about ones health and potential loss of assets if ones insurance doesn't cover a life threatening health condition. 
11:59 AM on 06/29/2012
As a federal judge, Roberts is entitled to lifetime medical insurance regardless of any preexisting condition. Thus, the outcome of the case had no impact on Roberts, personally.
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istanbulite
02:10 PM on 06/29/2012
Thanks, but you miss my point.   When one has epilepsy, it changes ones life.  While he has the security of wonderful health insurance, he also knows the tenuousness of health and life.   My point is that his medical condition has humanized him.
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Razzer
When the moon is in the 7th house, and Zyra collid
02:54 AM on 06/29/2012
Thank you for this most illuminating perspective!

Regret #1: vast numbers of Americans will not be exposed to this sophisticated explanation (after all, who in mainstream press would provide it? it won't sell large audiences on simple ideas and bright colors).

Regret #2: many within earshot, won't grasp this is how the system functions and that the machine presents both risks and benefits to the people.

Regret #3: many (including elected officials) who actually do hear and comprehend: will dispute, deny, and then promptly resume celebrating their mindless partisan power mongering, public demonstrations, and slogans.
02:33 AM on 06/29/2012
"... the public has accepted aggressive judicial review of legislation that should not be constitutionally suspect."

Faced with corruption that dwarfs the largess of the rail barons and late 19th Century tycoons, we have truly organized warfare to destroy any source or low cost and high profitability for the top 1% and businesses. "Winner-Take-All Politics" argues persuasively that this began in 1978. People haven't accepted the status quo. Instead, they are powerless with their vote to stop it and most have insufficient funds to influence it.
02:06 AM on 06/29/2012
The Constitution gives the federal government very limited, very specific powers. The Constitution reserves most powers to the stages or to the people. Today's ruling was wrong. We need to follow our Constitution and limit the federal government.
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IPredictARiot
US Military = largest socialist entity on earth
09:49 AM on 06/29/2012
Perhaps you didn't make it to Amendment #16. Keep reading the Constitution - it's not a chinese menu.

I find that the more someone talks about what the Constitution says, the less they actually know about it.
12:17 PM on 06/29/2012
While the Constitution does enumerate the powers given to the federal government, in many areas those powers are very broad. That's why the original states were unwilling to ratify the Constitution as proposed without the addition of the first ten amendments, commonly known as the Bill of Rights.

And if you carefully read the Constitution and the comments of those who were involved in writing it, you will see that limits on the federal government's ability to create and/or maintain a large standing military were among their principal concerns. They also were concerned about governmental intrusion in the private lives of citizens. Therefore, anyone faithful to the tenets of the Founding Fathers should be arguing for major reductions to the military and for a libertarian approach to matters involving personal freedoms such as abortion and drugs.
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wedgeantilles
Good shot, Janson!
01:34 AM on 06/29/2012
You can't give the government the power to regulate everything you do and then just tell yourself, "It's ok, we'll just kick anyone out of office who tries to pass a law that's unconstitutional." You have to scrutinize carefully to make sure you don't give them that kind of power in the first place.

This is just another article telling us to hate the supreme court. Imagine how it would've been if the law had been struck down!
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blackraisin
Life, Liberty, Property.
01:24 AM on 06/29/2012
"He also confirmed the view of the Constitution that made the attack on that law seem plausible. That constitutional view is itself radical."

Wait. So now even considering the constitutionality of a piece of legislation is radical? There are many views of Constitutional interpretation. And the left-wing media machine bullies the Supreme Court for months. Washington Post tells Scalia to resign. They called for court-packing, something that even Roosevelt learned was too radical. And now you are the victims. The Court hears cases in which the Constitutionality of a law is in question. This was such a case. As the opinion states, Congress's power to regulate commerce is limited to regulating commerce.