Unclear about all of this?  Over at the Washington Post, Ezra Klein cuts through the static and offers up a comprehensive breakdown of this week’s Supreme Court review of the Affordable Care Act.

Health reform opponents contend that the decision not to do something — namely, not buy health insurance — is economic inactivity, rather than activity, and therefore not a behavior the federal government can regulate. Health reform supporters argue that the decision to not purchase health insurance has an economic effect. An individual without coverage, for example, may not have the money to pay for an emergency room visit, sticking hospitals or taxpayers with the bill.


Jeffrey Toobin argues that the stakes are extremely high for the president.

The Supreme Court can make or break presidencies. Almost a dozen years ago, five justices thrust George W. Bush into the Oval Office. A generation earlier, in United States v. Nixon, a unanimous court effectively ended the presidency of Richard M. Nixon by ordering him to provide the Watergate special prosecutor with the White House tapes. Now, to a great extent, the court will render a verdict on the current president’s first term.


Richard A. Epstein says ‘strike it down.’

The Supreme Court should take this opportunity to reconsider the foundations of its commerce clause jurisprudence. The “wide latitude” given Congress is all too often used for enacting laws that support agricultural cartels and monopoly unions. These actions reduce social output, increase the federal footprint and stoke needless political controversy.


Doug Mataconis says don’t believe the spin.

The Supreme Court will be making audio and transcripts of each day’s hearings available approximately two hours after each hearing is concluded, so we’re likely to get near instant analysis of each day’s hearings along with much speculation about what the tenor the proceedings might mean for the outcome of the case. One of my first pieces of advice would be to not be quick to judge how a case will turn out by what questions are asked during the hearings, or which side the “experts” on cable television proclaim the winner or loser of a particular days arguments. For one thing, past Supreme Court oral arguments have made it clear that you can’t always tell how a case is going to turn out based on the questions that get asked during a hearing or a perception as to which side seems to be “doing better.”


Eric Alterman assesses the political ramifications and defends the president.

So was it a political mistake for Obama to put so many eggs in the health-care-reform basket? Well, a negative decision from the Supreme Court will certainly make it appear so. But the president can hardly be faulted for using his presidency do to something big, something he was elected to do, and something that, while politically risky, had the power to address a fundamental problem for the American economy that has bedeviled every Democratic president since Harry Truman. Certainly there are worse sins than doing everything possible to make your presidency matter.


David Sedaris recounts his experiences with socialized medicine as an expatriate in France.

One thing that puzzled me during the American health-care debate was all the talk about socialized medicine and how ineffective it’s supposed to be. The Canadian plan was likened to genocide, but even worse were the ones in Europe, where patients languished on filthy cots, waiting for aspirin to be invented. I don’t know where these people get their ideas, but my experiences in France, where I’ve lived off and on for the past thirteen years, have all been good. A house call in Paris will run you around fifty dollars. I was tempted to arrange one the last time I had a kidney stone, but waiting even ten minutes seemed out of the question, so instead I took the subway to the nearest hospital.


Sarah Kliff on why, regardless of outcome, the American health care system will never be the same.

In February 2009, Michael Zucker told a group of high-paid surgeons something they did not want to hear: The way they earned a salary was about to change.

Zucker is the chief development officer at Baptist Health System, a five-hospital network in San Antonio. For 37 common surgeries, such as hip replacements and pacemaker implants, it would soon collect “bundled” Medicare payments. Traditionally, hospitals and doctors had collected separate fees for each step of such procedures; now they would get a lump sum for treating everything related to the patient’s condition.

If a hospital delivered care for less than the bundled rate, while hitting certain quality metrics, it would keep the difference as profit. But if costs were high and quality was too low, Baptist would lose money. For the first time in their careers, the doctors’ paychecks depended on the quality of the care they provided.

Four surgeons quit in protest.


And the National Review calls the bill ‘an offensive against Constitutional government.’

The federal government has the power to regulate commerce among the states, but that power neither includes nor implies the authority to force individuals to purchase particular products. If it is read to include or imply that authority, then it must surely follow that the federal government may institute a compulsory calisthenic program for all Americans. The administration argues that an individual’s decision not to purchase health insurance has an effect, however minute, on health markets nationally, and that such decisions when aggregated have a large effect. But of course the same is true of individuals’ decisions to remain sedentary or eat too many sweets.

Photo credit:  Michael S. Williamson | Washington Post

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One response to “Obamacare and The Supreme Court”

  1. Balloon Boy says:

    Addendum: Ryan Lizza, writing for the New Yorker, on how Obama changed his mind on the individual mandate.

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