January 4, 2011 Celeste Monforton, DrPH, MPH 16Comment

After being sworn-in on Wednesday (1/5/11), the new Republican-controlled House of Representatives are promising to do at least two things this week:

(1) read on the House floor the U.S. Constitution, and
(2) repeal the Patient Protection and Affordable Care Act (PPACA), the healthcare overhaul bill that was signed into law by President Obama in March 2010.

Those aligned with the Tea Party movement are pumped up about these actions, but they seem like contradictions to me.

The U.S. Constitution, adopted in 1787, begins with the idealist proclamation:

“We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defence, promote the general welfare, and secure the blessings of liberty to ourselves and our prosperity, do ordain and establish this Constitution for the United States of America.”

The American Heritage Dictionary definition of welfare, as in “general welfare,” includes health, happiness, and well-being. The way I see it, a “more perfect union” that provides for the “general welfare” is one in which all Americans will have access to quality, affordable health care. An estimated 50.6 million Americans don’t have health insurance which limits many of them from accessing care. Another 1.5 million Americans file for bankruptcy protection because of unpaid medical bills—60% of all bankruptcies are related to health care debts. The American Dream becomes the American Nightmare when you can lose everything because someone in your family gets seriously ill.

The Founding Fathers’ goals to “establish justice” and “promote the general welfare” are wholly consistent 225 years later with national policies to control abusive practices of insurance companies. These included excluding from coverage individuals, even children, who had pre-existing conditions, or rescinding coverage after a person becomes sick. The new health care law makes these kinds of practices illegal. I hardly see these improvements as assaults on the goals of the Constitution.

We know there are Tea Partiers and members of the Republican Party who believe the PPACA is unconstitutional. That argument is playing out in federal court. I’m not one to rant about frivolous lawsuits, but the plain language of the Article 1, Section 8 of the Constitution seems pretty clear: authority is given to the federal government to

“regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”

Health insurance is clearly a commercial activity occurring among several States.

Article 1, Section 8 also gives Congress the

“power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defence and general welfare of the United States.”

Opponents of PPACA may not want tax dollars spent on programs to ensure all Americans access to quality, affordable health care, but that doesn’t mean it’s unconstitutional. It just means they don’t like it, that it doesn’t align with what they value, such as cutting federal spending, reducing taxes, and having a balanced budget.

I don’t agree with policy decisions that award our Defense Department an annual budget of $750 billion (which doesn’t include the cost of the Iraq and Afghanistan wars.) It seems excessive to me compared to the $15 billion divided over 10 years to support state and local communities’ public health capacity. I’d be foolish, however, to waste my time arguing the Defense Department’s budget is unconstitutional.

I wonder if those who are hung up about debating the constitutionality of the PPACA are not just trying to avoid a substantive discussion about values. Their priorities are cutting spending and reducing taxes, and letting those without access to affordable health care fend for themselves. I prefer policies that allow us to provide some measure of care for all, recognizing that a portion of my income will be distributed to others. To me, this is no different than a portion of my income being used to fund are nation’s war machine, our air traffic control system, or the National Cancer Institute.

The GOP leadership’s manifesto for running the 112th Congress is their Pledge to America. They’ll start their tenure tomorrow by swearing to preserve, protect and defend the Constitution. I hope that pledge also means they will not try to avoid policy debates on ways to “establish justice,” (e.g., environmental protection, workers’ rights) and to “promote the general welfare” (e.g., safer chemicals, climate change, nutrition) by hiding behind claims of unconstitutionality.

16 thoughts on “Promoting the “general welfare,” as in providing affordable, quality health care in the U.S.

  1. Interesting how we are all ready to “interpret” the Constitution to suit our purposes. You would propose to explore the meaning of “general welfare” in a broad sense. Although the Second Amendment is much more specific in its wording, gun control advocates would propose a more specific interpretation, based upon a single comma. In any case, I doubt the founding fathers included health care as “commerce.”

  2. You are throwing out some very red herrings. Very few if any people are claiming that it is unconstitutional for the federal government to regulate the interstate economic activity of health care. What some people are claiming is the the Constitution does not give the federal government the power to regulate economic non activity. The mandate requires people who are engaging in no economic activity to purchase a good or service from a private company that the individual does not want. Even most people who support the mandate recognize that this is an unprecedented expansion of federal power.

  3. I think it’s great that Congress wants to read the US Constitution out loud. It’s probably too much to hope that they’ll understand it, though.

    I just wonder if the republicans will skip over the parts they don’t like, such as the clause prohibiting religious tests for public office or the entire 14th amendment.

  4. Dan, many of us who cheered the Heller and McDonald rulings are no friends of the Tea party and its views on the Constitution or healthcare. As to healthcare not being viewed as commerce, I cannot imagine why it wouldn’t be.

    Mike, I suspect you would be right if the mandate made it a crime not to purchase health insurance. But merely bumping the income tax of those who don’t? There’s already inactivity that increases your tax bill, for example, failure to take out a large home mortgage.

  5. It is amazing people 10in deep into Obama no matter the capitalistic business asswipe things he’s been with Wall Street and the health industry. How CAN YOU not be upset about the FACT universally provided healthcare by govt was nixed and yet twist the Constitution to say it’s OKAY for government to forcefully push customers into the arms of fucking billionaire healthcare hegemony forcing costs higher for their profit and using the money for financial investments because insurance, banks and financial industry can swap money.

    Before Obama, as a firm progressive near commie I’ve decried the forced requirement to have the poor and others get private insurance for healthcare when my state was trying to look into imitating Mass. I’ll stay poor for free Medicaid/state supplied health or get a job for supplied insurance before I pay a penny to any company due to a mandate.

  6. Russel,
    Obama, The bill itself, the Congress and the courts have all found that it was not a tax, but fines and penalties for those who chose not to purchase health insurance.

  7. But for many hardworking families, affordable insurance can be hard to find. The new “Wise Health Insurance” is giving you more control over your family’s health care by expanding your options for health insurance and making them more affordable.

  8. @2 – The non-activity argument holds no water in the face of EMTALA, which guarantees everyone in the US (citizen or not) the right to access health care whether or not they can/will pay. Yes, I know that EMTALA specifies emergency care, but anyone in this country can present to the ER and receive a medical evaluation. Virtually no one sticks it out to death without interacting with heatlth care. The non-activity argument is simply a disguise for the argument “I want to access health care on my own terms.” When I can let your uninsured butt bleed to death on the front door of my ER without legal repercurssion, then we can talk about “non-activity.” Or is EMTALA unconstitutional, because it prohibits non-acivity?

  9. Our idea of “general welfare” has evolved since the Constitution was written; for instance, it now includes a prohibition on slavery and voting rights for women. It’s understandable that at any given time there will some disagreement about exactly what’s involved in general welfare – and we resolve these disagreements is by electing members of Congress and telling them how we want them to vote on the legislation that comes before them.

    It’s fine for members of Congress to have different ideas about what “general welfare” encompasses and how best to allocate a finite amount of tax revenue. What frustrates me is the way so many politicians feed the delusion that we can eat our cake and have it, too – no one’s going to touch your Medicare benefits or make you buy health insurance, but somehow we’re going to magically slash spending and make health insurance affordable!

    For starters, if the Republicans want to repeal the Affordable Care Act, they need to explain how they’re going to replace the $230 billion in deficit reductions the law is projected to deliver. Then they can explain how they plan to sharply reduce the number of uninsured and make insurance coverage more comprehensive, affordable, and available for everyone, even those with pre-existing conditions. Or, they can tell us they don’t actually care about doing those things.

  10. Liz,
    Very well said. I’m sure we’ll hear many Republicans say “just let the free market” take care of our inequitable, unaffordable health care system. Trouble is, that’s what we’ve been doing for decades and look at the mess we’re in.

  11. “General welfare” is in the eye of the beholder. How happy will you be when the political pendulum swings in the other direction? How would you like J. McCarthy and his buddies telling you what to buy? Clearly those pesky Japanese Americans were interned for “general welfare.” The Supreme Court thought that Americans should defer to Congress and military leaders so it must have been ok. I can’t understand why liberals aren’t quaking in their shoes about this. Conservatives are efficient and organized, they will not let this new power go unused.

  12. The nature of this blog is scientific, correct? Could somebody please provide me with a scientific justification, that is, one with a solidly rational basis, for the government’s intrusion into my life when it comes to looking after my health?

    Let’s toss any appeals to authority, whether it be a document written 200 years ago, or a document written 2000 years ago.

    Please explain the logical basis for socialized medicine.

  13. Matthew, if you’re looking for scientific studies, I recommend a report from the National Academy of Sciences’ Institute of Medicine, America’s Uninsured Crisis: Consequences for Health and Health Care. The report is an assessment of the research evidence on uninsurance’s effects on healthcare and health outcomes for both the uninsured and for insured residents of communities with high uninsurance rates. They found:

    “A robust body of well-designed, high-quality research provides compelling findings about the harms of being uninsured and the benefits of gaining health insurance for both children and adults.”


    “The available research suggests that when community-level rates of uninsurance are relatively high, insured adults in those communities are more likely to have difficulties obtaining needed health care and to be less satisfied with the care they receive.”

    The new healthcare law is designed to dramatically decrease the rate of uninsurance, and given the research findings we can expect this to improve overall population health in the US.

    Whether improving population health is more important than minimizing government involvement in healthcare is a value judgement you can make for yourself.

  14. “The non-activity argument holds no water in the face of EMTALA, which guarantees everyone in the US (citizen or not) the right to access health care whether or not they can/will pay.”

    Actually, it does because Congress cannot do in two steps that which is forbidden in one. Otherwise, Congress could create or authorize Bad Regulation A and then Unconstitutional Law B and argue “necessary and proper” because A ruined everything. Judge Vinson was rather clear on this, and that is while ACA will go down 5-4.

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