SCOTUS PPACA Day 1: The Calm Before Storm

On my way to dinner on Monday, after spending the day covering the various protests and rallies on the Supreme Court steps in Washington, DC, I passed the Ronald Reagan building, where there stood a statue with the inscription: “The voice of reason is more to be regarded than the bent of any present inclination.” If only such wisdom had been heeded by those I saw arguing the merits and flaws of the Patient Protection and Affordable Care Act (PPACA), the fate of which will be argued this week, from Monday through Wednesday.

Today, the arguments centered on an obscure bit of the law that essentially begged the question: can you overturn the individual mandate before it formally takes full effect in 2015? Both sides of the argument were eager to have this matter settled now, and not surprisingly, the Supreme Court decided that it would be appropriate to hear the other arguments regarding PPACA’s potential overturn.

The real fireworks will kick off tomorrow, when the arguments begin over the Constitutionality of PPACA’s individual mandate – the requirement that all buy at least some minimum level of health insurance. On Wednesday, the arguments will focus on whether, if one part of PPACA is overturned,  the entire thing be overturned? Separate arguments will go over how PPACA impacts Medicare, but the heart of all this will be Tuesday’s arguments over the individual mandate.

The arguments will be passionate ones, and already, those outside the Court spent the day rallying around their own reasons for why PPACA should stay or go, and trying to shout over the noise of the other side. As I walked among the crowds in front of the Supreme Court, I noticed a few common themes that made me deeply appreciate that the fate of PPACA was being decided within the SCOTUS building rather than out in front of it.

The crowds today were overwhelmingly pro-PPACA. The largest group was People of Faith for Health Care, a religious group who felt that PPACA needed to stay law because it protects the poor and helpless. There was Doctors for America, a group for medical professionals and medical students who supported PPACA because they feared that without it, patients would no longer be able to afford medical services. The National Association of Women was on hand to support PPACA’s provisions concerning the guarantee of contraception (a relatively late-breaking issue that I think has only served to distract everybody from the larger realities of what PPACA is, does and means). And there were a number of other miscellaneous supporters who seemed to support no particular cause, but whose reactions showed how much they thought PPACA was a good idea that needed to stay.

Central to the arguments of almost all of these groups was the tenet that universal access to healthcare is a basic human right. In a country as advanced and as wealthy as the United States, so goes the logic, there is no excuse for why anybody should go uninsured. Every American has a right to be healthy, and a right to the medical procedures required to return one to health when they fall ill. Fair enough; anybody who travels abroad, especially to countries less developed than this one, can appreciate the notion that Americans can surely support a system that makes sure everybody has access to at least basic medical services.

But what none of these groups seem to appreciate is that if healthcare is a basic human right, like freedom of speech, then there comes with it a duty to exercise that right responsibly. We are in the grip of a crippling obesity epidemic, caused largely because a quarter of all Americans make choices every day that lead them to obesity and because another quarter make choices that merely leave them overweight. If there is a right to healthcare, then all of these people really should be willing to change their lives in order not to abuse that right. After all, if freedom of speech still means you can’t yell “Fire!” in a crowded theatre, then freedom from medical problems means you can’t knowingly bring those problems upon yourself. That should be the logic, but somehow, I doubt anybody was thinking things through that much. What they were arguing for, really, was an entitlement without a lot of thought toward cost or logistics.

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