Obamacare: Examination and Response
An appraisal of the Affordable Care Act and-- with some guesswork-- its tricky politics. Then, a way to capture major new revenue, even paying down existing Medicare debt, without raising premiums or harming quality care. Then, an offering of reforms even more basic, but more incremental. Finally, the briefest of statements about the basic premise.
There are exceptions, but in the interest of preserving their own flexibility, the three branches of Constitutional government generally try to stay out of each other's way. The Constitution specifies no remedy short of impeachment for getting on another branch's turf, presumably because the threat of retaliation would make the other branches hold back from it. To resort to impeachment requires a possibility that a particular turf battle qualifies as "high crimes and misdemeanors". That term is so vague it probably implies a threat of exile or execution, which in the past were only considered in hereditary monarchies with a succession issue. While King James I was beheaded for falling afoul of his parliament, many other Anglo-American governments have been changed peacefully since that time. In any event, the events attendant on the passage of the Affordable Care Act were exciting enough that few realized it might soon appear before the United States Supreme Court. Immediately after enactment, twenty-some state Attorney Generals sued that the Affordable Care Law exceeded the limited powers granted by the Constitution to the federal government. Following a puzzling resolution of that issue (that its penalties were really a tax), the Speaker of the House soon announced he was also planning to sue because the President's actions did not "faithfully" match the intent of Congress. Representing only one half of the Legislative branch probably does not give the Speaker sufficient "standing" but if the coming elections provide him with the concurrence of the Senate, it seems unlikely the Court would permit a President to veto his own impeachment.
Responding to this unexpectedly legal turn of events, this book about healthcare and its insurance could, unfortunately, be forced into a series of national debates about Constitutional Law. In spite of strong misgivings that lawyers knowing little about medical care, were further digressing to safer ground from health care, through insurance into Constitutional Law, there seems little choice but to hang on, waiting for an eventual opportunity to get back to medical care. We can consider it lucky that James Madison was anxious for the Constitution to be simple enough for the public to understand. And further lucky that Gouverneur Morris, the "Penman of the Constitution", proved to be talented enough to make it so.
All legislative Powers herein granted shall be vested in a Congress of the United States, which shall consist of a Senate and House of Representatives.
|Article 1, Section 1.|
So long as Congress 'shall lay down by legislative act an intelligible principle to which the person or body authorized to [exercise the delegated authority] is directed to conform, such legislative action is not a forbidden delegation of legislative power.'"
|J,W.Hampton v US, 1928|
Turning in a somewhat different judicial direction, many snarls in Medical Care trace to Legislative action; reforms almost always begin in that Branch. But the same logic applies to Courts. If a problem begins with Constitutional design or Judicial action, its reform might best begin within Courts, because the other Branches may feel inhibited. Such initiation is not necessarily "judicial activism". Sometimes Court action alone is needed if Court interpretations have changed an issue; anti-trust is an example. But the most important need for Court initiative is in Tort Reform, where Chief Justices have administrative jurisdiction. Other branches may feel it is not their place to meddle; some Chief Justices may feel administrative intervention is not to their taste. If other problems grow out of Constitutional design or Judicial action, it can also be awkward for other Branches to deal with them. Still, other problems straddle the Branches; Judicial action might at least be considered. For example, hardly anyone would have predicted a collision between the President and Congress while his party dominated both branches; that was true during the brief period after the Affordable Care Act was enacted. The way it was enacted so enraged a segment of the population that political control soon shifted to the opposition in the House of Representatives, and threatens to shift still further in the November 2014 Senate elections. As Mr. Dooley famously observed, "The Supreme Court follows the election returns."
The Affordable Care Act has 450 sections, so it may be some time before it is legitimate to criticize a failure to write and implement all the sections, even though the law passed the House of Representatives in a single day, nearly three years ago. It is therefore much more likely a charge of failing to enforce the intent of Congress faithfully would take the form of asserting that regulations were promulgated based on no underlying intent expressed in the law. On the other hand, just what a clever lawyer can do with a President who promises on television not to do something which has already been done after the direction not to do it is written in (Section 1251) the law, may prove to be a greater challenge.
The Legislative cannot transfer the Power of Making Laws to any other hands.
|John Locke, 1690|
Meanwhile, in the increasingly uncertain climate of an Obamacare decision affecting medical care, we offer a few suggested areas where the Supreme Court might take actions as the initiator, rather than the passive referee, of relevant rules. The U.S.Supreme Court might be urged to: 1) Mandate income tax equity for health insurance, disregarding who pays the premium and how, 2)Reconsider the 1982 Maricopa Case; at least, remand it for trial, 3) Assert Judicial leadership in Tort Reform. 4) Define ground rules for coordination between Regulations and Statutes, 5)Review the inconsistencies between Obamacare and ERISA, particularly the question of who has standing in the two instances. 6) Review the rules of the House and Senate, particularly as they apply to House-Senate reconciliation of two versions of a bill. If possible, the Legislative Branch should request this kind of intrusion, first.
2624 State and Federal Powers: Historical Review
2250 Obamacare's Constitutionality
2289 Roberts the Second
2625 What Can Supreme Court(s) Do About Tort Reform?
2592 More Work for the U.S. Supreme Court: Revisit Maricopa
2613 ERISA Is Thrust Into the Battle
Originally published: Sunday, December 22, 2013; most-recently modified: Friday, May 10, 2019