5 little dictators

I spent 6 hours this week listening to the entire Supreme Court oral arguments over the health care law. It was a chilling experience. The more these justices asked questions the more it became alarmingly clear that 5 of them are reaching for a justification to invalidate the entire law. I hope I am wrong, I really really do. But if this is what is happening, if five unelected judges are about to throw out the most important social legislation in 45 years, the implications for our society, our system of government, and for our most vulnerable citizens are staggering.

This is not a perfect piece of legislation by any means, but it was passed by both houses of Congress in a torturous process and signed by the President. It would insure 30 million people who right now have no access to quality health care. The expansion of medicaid alone would cover 15 million people. This offers some hope to the people in this country who suffer every day under a system of health care apartheid where what care you get is dependent not on your health condition but your economic condition.

It was clear from the arguments that the five conservatives are looking for a legal justification to throw out a law that they just don't like. If they can do this, if they basically say to congress, "you have no power to solve big problems", then what is the point of debating these issues at all? What is the point of elections? This has been the conservative critique of liberal "judicial activism". But for the most part, "liberal" decisions have not affected major economic legislation. The government cannot tell you who to pray to or that you must carry a pregnancy to term but it can tell you that you have to pay your workers minimum wage, you can't poison people with your food products, and you have to contribute to social security or in this instance national health care.

In a roundabout way, as Justice Ginsburg noted. The mandate is basically the federal government's way of providing health care while keeping a private system. There is no doubt the Federal Government could require a payroll tax for health care and then provide public insurance based on that. In this instance, the tax is basically the mandate (which is levied like a tax in a progressive manner through subsidies that mean the lower your income the lower your premium until you have no premium under expanded medicaid).

But none of this matters if the court decides to strike it down. And this problem will not be solved anytime soon if this happens. It practically took a nuclear war to get this modest legislation through the congress. In the meantime, more people will suffer and die.

As the solicitor general stated at the end of his argument yesterday ... One can only hope that a majority of these people who will never know what it is like to wonder if they will get the health care they need will listen.

15. "But if I may just say in conclusion that the provision, the Medicaid expansion that we're talking about this afternoon and the provisions we talked about yesterday, we've been talking about them in terms of their effect as measures that solve problems, problems in the economic marketplace, that have resulted in millions of people not having health care because they can't afford insurance. There is an important connection, a profound connection, between that problem and liberty. And I do think it's important that we not lose sight of that. That in this population of Medicaid eligible people who will receive health care that they cannot now afford under this Medicaid expansion, there will be millions of people with chronic conditions like diabetes and heart disease, and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty. And the same thing will be true for -- for a husband whose wife is diagnosed with breast cancer and who won't face the prospect of being forced into bankruptcy to try to get care for his wife and face the risk of having to raise his children alone. And I could multiply example after example after example. In a very fundamental way, this Medicaid expansion, as well as the provisions we discussed yesterday, secure of the blessings of liberty. And I think that that is important as the Court is considering these issues that that be kept in mind. The -- the Congress struggled with the issue of how to deal with this profound problem of 40 million people without health care for many years, and it made a judgment, and its judgment is one that is, I think, in conformity with lots of experts thought, was the best complex of options to handle this problem.

    Maybe they were right; maybe they weren't. But this is something about which the people of the United States can deliberate and they can vote, and if they think it needs to be changed, they can change it. And I would suggest to the Court, with profound respect for the Court's obligation to ensure that the Federal Government remains a government of enumerated powers, that this is not a case in any of its aspects that calls that into question. That this was a judgment of policy, that democratically accountable branches of this government made by their best lights.And I would urge this Court to respect that judgment and ask that the Affordable Care Act, in itsentirety, be upheld. Thank you."