This week, the Supreme Court heard oral arguments concerning the constitutionality of the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare. Several arguments concerning the individual mandate were made on Tuesday, and all of them merit some analysis.
A major claim against PPACA is that the Commerce Clause gives Congress the power to regulate existing economic activity, but not the power to require people who are not currently engaging in economic activity to begin doing so. By requiring people who lack health insurance to purchase such insurance, the mandate of the PPACA crosses a line. Some would argue, as Solicitor General Verrilli did in his main brief, that because almost everyone will eventually need medical care, everybody is already engaged in economic activity to decide how to finance said medical care, and that the mandate simply regulates how and when the currently uninsured must go about performing that activity. This philosophy has a problem, however. It denies us the freedom to take our own risks and suffer our own consequences. The Solicitor General then stated that the prohibition against discrimination for pre-existing conditions is unworkable without the mandate, as it encourages freeloading by people who wait until they become ill to purchase insurance. But because the penalty for not getting insurance is less than the cost of maintaining insurance and the penalty has no enforcement behind it, people can simply refuse to pay the penalty and wait until they need coverage, defeating the whole purpose of the penalty.
The lawyers for the plaintiffs, along with several Justices, pushed back with three hypothetical examples. Justice Alito began by asking Solicitor General Verrilli whether Congress could mandate that everyone should have burial insurance. After all, everyone dies, and failure to obtain burial insurance shifts the costs to the public. This is not the best argument, since the bodies of such people can simply be cremated without wasting space for a pauper’s grave, and the analogous action for healthcare, namely allowing people to take their own risks and suffer their own consequences, is illogically discarded by most government officials. Similarly, Chief Justice Roberts asked whether everyone could be forced to purchase a cell phone for emergencies, and attorney Clement made a slippery slope argument that Congress could require everyone to buy an American car. The idea of requiring everyone to have a cell phone exposes people to the possible cancer risk of cell phone use, for which there is no equivalent in the healthcare mandate. The car argument, while initially compelling, is unrelated to the case at hand because it is more of a protective tariff issue, in that Congress could make imported cars prohibitively expensive with import tariffs. Congress unquestionably has the power to do this, so it is not up for debate, as the healthcare mandate is. The Solicitor General attempted to explain how these cases are different from the healthcare mandate, but he did so from a rather statist perspective to defend the PPACA, rather than answering fundamental libertarian questions about why it is the responsibility of the government to save its citizens from themselves in the first place.
Essentially, the question of the mandate and the supposed need to provide medical care for everyone boils down to the moral question of the difference between actively killing a person and allowing a person to die by inaction. Actively killing a person without due process of law is the worst possible violation of the non-aggression principle against said person. Doing nothing to spare a life might be morally objectionable from certain points of view, but there are credible moral philosophies which do not count this as any sort of evil. This brings to mind the question from one of the Republican debates about whether society should allow someone who chose not to protect himself with health insurance to die, and for once, the crowd was right and Ron Paul was wrong. Those who make bad decisions fail. Those who make bad enough decisions die. There is nothing evil about this. It is simply nature at work. The PPACA is ultimately another manifestation of the socialist idea of bailing out those who have made bad decisions. Such an act is not only unprovided for in the enumerated powers given to the federal government by the Constitution, but it is also an affront to natural selection.