This morning, the United States Supreme Court made its landmark decision to uphold the health care reform law. I am very happy about it for a number of reasons:
- I won a $1 bet. As I described in a previous post, I bet my brother-in-law, an attorney from Chicago, that the law will be upheld. I will be driving to Chicago this weekend to attend my father’s 75th birthday. I’ll see my brother in law there. He’s a trustworthy guy, so I’m confident he’ll pay up.
- I was right about the majority argument. Like my brother-in-law and most of the pundits, I was originally focused on the question of whether the individual mandate provisions of the reform law represented an unconstitutional expansion of the federal government’s power to regulate interstate commerce. My first blog post on the subject explored that issue. But, then I read an interesting piece in the Atlantic by Jack Balkin, a constitutional law professor from Yale. As I explained in my second blog post on the subject, Balkin argued that the penalties associated with the controversial individual mandate should be considered a tax, and are therefore a constitutional exercise of the federal government’s taxing powers. I found the argument convincing. But I never heard anything more about that line of reasoning until this morning, when we learned that this argument is exactly the one that Chief Justice Roberts made in his majority opinion.
- The law was upheld with a minimum of expansion of federal power. I shared my brother-in-law’s concern that if the law was upheld based on an expansive view of the interstate commerce clause, it would have the effect of dramatically expanding the power of Congress to dictate how we all live our lives, without being constrained by the political unpopularity of raising taxes to pay for it. But Chief Justice Roberts called a spade a spade. Despite the terminology of the law itself, and despite the repeated assertion by President Obama that the law does not raise taxes, Roberts declared at least the individual mandate penalty to be a tax. I do still think that the reform bill has the effect of expanding expectations about the role of the federal government in our lives, and so I still have some concern about that. But, of all the arguments that could be made to uphold the reform law, I think the one Roberts selected is the least bad in terms of expanding government powers.
- We can continue the journey toward a more civilized and compassionate health care system. Almost nobody is asserting that the health care reform law is perfect. But, in my opinion, it is a step in the right direction. It is better than creating a government-run monopoly. It is better than waiting forever for each of 50 states to exercise their authority to compel people to buy health insurance. It helps millions of Americans have a sense of security. And, it underscores that our strong tradition of individualism is balanced against our sense of duty to one another as Americans and humans.
- I am energized to continue health care improvement. Over the last few years, our field has built up some momentum in transforming health care. Health care leaders were feeling a sense of urgency to increase their capabilities in population management, analytics, lean process improvement, clinical integration and health information technology. I feared that if the health care reform law was struck down, it could lead those leaders to relax for a few years to wait and see what comes next. I am excited by the prospect that our field can continue to build momentum that spills beyond the limited confines of the reform law itself to allow us to make more fundamental progress in the care delivery system itself.
- Oh, and did I mention I won a $1 bet?