Pres. Obama's decision to ask the court to expedite the legal challenges to the Affordable Care Act was questionable and questioned, probably very much within the administration and probably in Obama's personal internal debate. Pushing it off until after election, which seemed not difficult given how long the judicial process generally takes, looked safer to many, me included. Much as those of us who support single-payer (Medicare For Everyone) were upset the president didn't give it a chance and push harder for a public option, the fact is taking up health care reform was a huge risk, the sort of risk we now know Obama will sometimes take, so his decision to get health care challenges decided before the election looks less surprising in retrospect, and given the result, Obama gets to claim vindication.
Two years ago I wrote "Conservatives were right, this was Obama's Waterloo" to mock Sen. Jim DeMint's claim that Obamacare, as Republicans dubbed it and as Democrats have decided is actually a good name (Obama - cares, we can live with that), would be Obama's final defeat. The Supreme Court ruling isn't everything we could wish for (more on that below) but it's a big win for Obama, so it seems appropriate to bring this back:
Sen. Jim DeMint, R-SC, boldly proclaimed that healthcare would be Obama's Waterloo, and other conservatives joined in.
Well, they were right, this was Obama's Waterloo. Sen. DeMint, meet Barack "Wellington" Obama:
[author's note: Obama didn't actually pose for this. Nor was he really at Waterloo or even alive in the 19th century, not even in Kenya. I can't confirm that he was an extra in "Sharpe's Rifles".]
Admittedly without all the particulars of a long opinion yet gone through, I can pick out three downsides of this decision:
1. Medicare For Everyone just got harder. We won't be able to argue that the court just said that reforming the private health insurance industry is effectively unconstitutional, so it's single-payer or the old system. Doesn't mean we quit trying, but we can't frame it as so stark a choice now. The argument of providing access just got much weaker. Though given that tens of millions will have access when they otherwise wouldn't, it's still a very good day.
2. The ability of the federal government to withhold Medicaid funds was narrowed. States that refuse to extend coverage lose only the funds for the extension, not all Medicaid funding. State governments that just want to obstruct, however they can, can effectively refuse to allow more of their poor to use Medicaid, which sounds like a dreadfully callous idea, but the poor don't have lobbyists, and neither compassion nor practicality consistently beats ideology and obstinacy.
3. Roberts joined the other conservatives in saying they would have overturned the whole law on the basis of the commerce clause. How ridiculous. It isn't just the health care is such a huge part of the national economy, but of course it crosses state borders. Even though health insurance has largely been regulated by the states, it's not like people don't buy insurance in one state and get sick or injured in another. My employer is based in Missouri and I have a Missouri plan, but here I am using it in Minnesota. Yes, that's interstate commerce. The framers of the Constitution included the commerce clause not as an afterthought, but to remedy what they considered one of the biggest defects of the Articles of Confederation. That's right, the commerce clause is one of the primary reasons the Constitution was drafted. Of course it extends the power of the federal government --- that was the framers' intention. From Federalist 42, James Madison:
The defect of power in the existing Confederacy to regulate
the commerce between its several members, is in the number of those which have been clearly pointed out by experience. To the proofs and remarks which former papers have brought into view on this subject, it may be added that without this supplemental provision, the great and essential power of regulating foreign commerce would have been incomplete and ineffectual. A very material object of this power was the relief of the States which import and export through other States, from the improper contributions levied on them by the latter. Were these at liberty to regulate the trade between State and State, it must be foreseen that ways would be found out to load the articles of import and export, during the passage through their jurisdiction, with duties which would fall on the
makers of the latter and the consumers of the former. We may be assured by past experience, that such a practice would be introduced by future contrivances; and both by that and a common knowledge of human affairs, that it would nourish unceasing animosities, and not improbably terminate
in serious interruptions of the public tranquillity. To those who do not view the question through the medium of passion or of interest, the desire of the commercial States to collect, in any
form, an indirect revenue from their uncommercial neighbors, must appear not less impolitic than it is unfair; since it would stimulate the injured party, by resentment as well as interest, to resort to less convenient channels for their foreign trade.
But the mild voice of reason, pleading the cause of an enlarged and permanent interest, is but too often drowned, before public bodies as well as individuals, by the clamors of an impatient avidity for immediate and immoderate gain.
The necessity of a superintending authority over the
reciprocal trade of confederated States, has been illustrated by other examples as well as our own. In Switzerland, where the Union is so very slight, each canton is obliged to allow to merchandises a passage through its jurisdiction into other cantons, without an augmentation In Germany it
is a law of the empire, that the princes and states shall not lay tolls or customs on bridges, rivers, or passages, without the consent of the emperor and the diet; though it appears from a quotation in an antecedent paper, that the practice in this, as in many other instances in that confederacy, has not
followed the law, and has produced there the mischiefs which have been foreseen here. Among the restraints imposed by the Union of the Netherlands on its members, one is, that they shall not establish imposts disadvantageous to their neighbors, without the general permission.