The Supreme Court can recognize the legitimacy of Congress’ Commerce Clause power to make you buy health insurance without deciding it can make you buy broccoli.
At the recent Supreme Court arguments, Justice Antonin Scalia suggested that if Congress can regulate interstate commerce by making you buy health insurance, it can make you buy anything — like broccoli, for example.
That’s not true. There is a big difference between broccoli and health insurance!
Here it is: If you don’t buy broccoli, no one else is going to buy it for you. In contrast, if you don’t buy health insurance, the rest of society has to pay for the emergency health care you are almost certain to use eventually.
Why does society pay for people’s emergency health care but not for their broccoli? Because in our society, we generally don’t let people just die in the streets. If you don’t have health insurance, you will have a terrible time getting routine and preventive care, or following up on your doctor’s orders. But hospitals are required by law to provide emergency care and they do it. Somebody has to pay for it.
If you get emergency treatment but don’t have insurance, the hospital normally will send you a bill, frequently for thousands of dollars. Most people can’t afford these bills, at least in full, so the hospital usually has to eat much of the cost. The hospitals pass it along in the form of higher charges to those who do have health insurance (usually through their employers). This causes a huge impact on the national health insurance market – raising the price by over $1,000 per family per year.
The failure to buy vegetables, or virtually any other product, doesn’t give rise to such dramatic interstate market effects on everyone else. This is why Congress has the power to require people to buy health insurance but not necessarily the power to require the purchase of other products where failure to buy them has only a remote and uncertain impact on interstate commerce.
Benefits beyond economics
Of course, upholding this law will have beneficial impacts way beyond mere economics. People without health insurance may get emergency room care at society’s expense, but they don’t get much else. That’s not only completely inefficient, it’s completely dangerous for their health.
According to a study by Harvard Medical School, one American dies every 12 minutes from lack of health insurance.
The uninsured — adults and children — often go without screenings and preventive care. The uninsured are more likely to be diagnosed with a disease in an advanced stage, when treatment is least effective and most costly, and they may well die from it.
Research shows that these conditions greatly improve when individuals obtain health insurance.
Looking at children, for example, research shows that children with insurance are more likely to get well-child care, immunizations and prescription medications; serious childhood health problems are more likely to be identified early and children with special health care needs are more likely to have access to specialists; children with insurance experience fewer avoidable hospitalizations, have improved asthma outcomes and miss fewer days of school.
‘Individual mandate’ is critical
Everyone deserves adequate health care, and the way that is obtained in this country is through health insurance, both private and public. We can’t demand that insurance companies accept everyone for coverage if healthier people aren’t required to buy insurance like everyone else. Otherwise the price goes through the ceiling.
This is a national humanitarian as well as economic problem, and the “individual mandate” is critical to its solution. The Supreme Court can recognize the legitimacy of this exercise of Congress’ Commerce Clause power without deciding that Congress has the power to make you buy broccoli!
Estes is a health policy analyst for New Mexico Voices for Children.