Back when the big health care law was little more than a dream, a prominent figure spoke out against the idea of forcing people to get health insurance. He said that would be like solving homelessness by passing a law making people buy a house.
A step too far. Not the American way.
That was Barack Obama, presidential hopeful. Like every leader and many citizens, he was searching for the right balance between what government should do for people and what people should do for themselves.
His answer on that point changed. But in the United States, the question never does.
A debate that began in the bloody throes of revolution has persisted through history’s pendulum swings left and right: the New Deal activism of Franklin Roosevelt, the pushback of Ronald Reagan, the squishy years of Bill Clinton’s ‘third way” and George W. Bush’s ‘compassionate conservatism,” the ambitious agenda of Obama.
Then that debate landed in a Florida courtroom, where U.S. District Judge Roger Vinson examined the Patient Protection and Affordable Care Act, marveled at all its moving parts, likened it to a ‘finely crafted” timepiece and took a hammer to it.
‘The Act,” he wrote, ‘needs to be redesigned and reconstructed by the watchmaker.” Meaning Congress.
Vinson ruled it was unconstitutional for the government to force people to get health insurance. Never before, he said, has Congress made people buy something ‘just for being alive and residing in the United States.”
The law remains in effect pending appeals and a likely Supreme Court showdown. The judicial scorecard now is 2-2 for and against the law in challenges brought by states.
In most other richer countries, it’s an article of faith that government will help with health care, just as it provides public education and tightly controls guns. Universal health care programs are a source of national pride despite vigorous complaints about service and cost.
But in the U.S., the unfolding court cases and political donnybrook have made clear that the law, a massively complex instrument that stuffs a dozen acts together and touches every aspect of medicine, hit a simple nerve.
Americans don’t yield easily to being told by their government what to do.
They are suspicious that a helping hand will become a heavy hand — that Washington’s offer of end-of-life counseling will turn into a federal death panel, that an attempt to control childhood obesity will lead to the feds crushing grade-school bake sales.
Reagan’s cry that ‘government is not the solution to our problem, government is the problem” echoes on one side of the debate.
Even so, Americans elect many Democrats.
They elected Obama, who ran on an agenda packed with hundreds of specific things, large and small, that he promised the government would do.
Indeed, the federal government has been a growing presence in Americans’ lives for generations. Due mostly to Medicare and Medicaid, for example, Washington picks up 43 percent of the nation’s health bills, a share that the new law is expected to raise only incrementally in the years ahead.
The government makes laws to keep Americans safe from toxic water and air, to ensure baby strollers aren’t dangerous and to regulate precisely how many maggots and mites a can of food may properly contain.
Americans might possess a residual frontier mentality, but those pioneers never saw a Social Security check — and woe to any politician who tries to pry that entitlement out of anyone’s hands now.
Ask people what they want the government to do and the answers are none too helpful for leaders who are trying to divine which way the winds are blowing.
On the health care law, public opinion is about as complicated as the statute itself. In an AP-GfK poll last month, 41 percent opposed the law and 40 percent supported it, just one of a battery of surveys that have pointed to widespread public unease about the overhaul but an unwillingness to just let it go.
Two months earlier, an AP-CNBC poll asked people about cutting the federal budget and found scant support for taking money away from specific services.
On programs big enough to make a difference, like Social Security, farm subsidies and Medicare, people were split. And they were broadly against cutting money for education or homeland security.
Vinson, a Reagan appointee who paid out of pocket for the birth of his first child, presided over a case in which both sides and the judge visited the touchstones of history that have helped shape what the federal government can and cannot force everyone to do.
To aid the government’s case, it was pointed out that the Judiciary Act of 1789 required men to serve in a posse. There have been mandates to serve on a jury, participate in the census, submit to eminent domain and exchange gold bullion for paper currency.
The court reviewed the 1942 case of poor Roscoe Filburn, an Ohio farmer who was prosecuted for growing 239 more bushels of wheat than the federal government allowed even though the grain was to feed his own chickens, not manipulate prices. The Supreme Court ruled against him, extending Washington’s power to regulate commerce.
In his ruling, though, Vinson ended up in the pocket of the tea party — the Boston Tea Party, that is. It is difficult to imagine, he said, that a people who revolted against Britain’s colonial tea tax ‘would have set out to create a government with the power to force people to buy tea.”
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