Chief Justice John Roberts reminded that the Supreme Court does well in showing “a general reticence to invalidate the acts of the nation’s leaders.” He emphasized the precedent: For the court to strike down an act of Congress, the lack of constitutional authority must be “clearly demonstrated.” Roberts then proceeded to explain how he joined with four liberal justices to uphold the overhaul of the country’s health-care system.
Thus, the surprising turn involved more than a victory for the Obama White House, the reform package a leading accomplishment of the president’s term. It also marked an appropriate, and reassuring, display of judicial modesty.
Roberts rightly noted that it is not the high court’s job “to protect the people from the consequences of their political choices.” Elected leaders are held accountable at the polls, as they will be in four months or so. If Republicans gain sufficient clout in Washington, they can fulfill their pledge to repeal the health-care overhaul.
As Justice Ruth Bader Ginsburg argued in a concurring opinion, the court had sound reason to hold that the broad commerce powers of Congress allow for an individual mandate, the controversial requirement to purchase health insurance. No one escapes health care, and refusing to buy coverage affects significantly the market.
Roberts joined four fellow conservatives in rejecting that view. They bought the notion that Congress somehow has aimed to create commercial activity so that it can impose regulations. Fortunately, the chief justice didn’t stop there. He crafted a compromise, concluding that the penalty for failing to buy coverage amounts to a tax. He cited the wide power of Congress to levy taxes, something the court has an obligation to respect.
Thus, the individual mandate survived — along with the law as a whole. The mandate is crucial. It allows for other provisions to work. Insurers are required to cover more people, part of bringing coverage to 30 million people who now are uninsured. Mandate the purchase of coverage, and insurance firms have a revenue stream that helps with the cost and makes coverage more affordable.
More, the mandate reflects a foundation of insurance: The healthy subsidize the sick or injured, knowing the near certainty is, they eventually will encounter misfortune and need similar help.
Part of the expanded coverage involves such things as insurers no longer discriminating based on pre-existing conditions, seniors gaining improved drug benefits, young people remaining on their parents’ policies. Medicaid would expand, though the court limited the federal government’s leverage on states. Most telling, the private market would be tapped, especially through state exchanges, where those without employer coverage will find a range of policies, subsidies available to assist with the cost.
No doubt, the mandate and the overhaul will remain at the front of the campaign, Republicans and Democrats quickly recalculating their positions. What deserves more than passing attention is the achievement of the chief justice and the rest of the majority. The overhaul suffers from flaws, often the product of compromise. The reform package also serves as a promising framework for addressing glaring problems, including the high cost of health care, the expense crowding other national priorities. The provisions include penalizing hospitals for high rates of preventable infections and establishing an independent board of experts that would move to implement cost-saving changes in processes and procedures.
This is the possibility the court has preserved, a necessary experiment that addresses the burdensome overall expense and the hardships so many face, medical calamities accounting for 60 percent of personal bankruptcies.
That balancing act is formidable, and no less of a priority than a stronger economy. It points to following the court majority’s lead, finding ways to bridge differences at critical junctures. Whether Republicans admit it or not, the overhaul contains many of their ideas, starting with the mandate and the exchanges. Democrats dropped the public option. The Obama team worked to accommodate concerns of drug-makers, insurers and other private players in health care.
As decision day approached in the health-care case, many analysts fretted about a court becoming defined by partisanship, its reputation at risk. The chief justice, in his majority opinion, wisely stepped back from that brink. There resides a lesson for others in Washington.