Careful: You might get what you wish for

My friend Will Wilkinson has a nice post over at the Economist regarding the politics of the ACA being overturned by the SCOTUS next week.  Increasingly, the legal community thinks the law will be upheld, and that it will be the Chief himself who casts the swing vote.  Who knows.  As many have noted over the last few weeks, few expected the case to make it to the Court in the first place. Will’s most interesting point is an ironic one: that the repeal of Obamacare, which famously implements a GOP-designed system piloted in a GOP-led state, may lead to a more successful case for a single-payer system.

I am not a good constitutional scholar but I am a scholar with a good constitution, and I’ve been reading everything I can on legal blogs supporting both the overturn and uphold perspectives.  As has been widely reported, the core constitutional argument against the mandate is that the Government can’t regulate the inactivity of not buying insurance, to which the retort is that the Government can regulate interstate commerce and so it has not exceeded its authority.  A fringe idea is that the penalties levied by the Feds against those who don’t buy is really a tax by another name— and the Government sure can do that. 

A more interesting question to me is whether one can be “inactive” at all in a health market. We all use these services eventually, even those who are not insured by choice.  And is anyone actually uninsured by choice, the same way I wear adidas by choice or chose a salad for lunch today?  They’re uninsured because they can’t afford it.  It’s a little like saying that your 5-star hotel is open to everyone. Who can pay.

Some choice.