Obamacare is unconstitutional. The federal government lacks the authority to compel citizens to engage in commerce. Let’s hope at least 5 of the 9 justices on the Supreme Court get this one right. But while this issue is the focal point of libertarians and conservatives, there’s a deeper concern that is sometimes overlooked.
The purchase provision in Obamacare is unconstitutional because crafters of the legislation wanted to retain the illusion that Americans would retain control of their own healthcare by purchasing their own insurance. This is the key funding mechanism for the scheme, but it could have been circumvented by going straight to a single-payer plan funded through (higher) tax revenues. Democrats are not united behind a single-payer scheme yet, so the purchase provision was as far as they could get. If the Supreme Court strikes down all or part of the plan, there’s nothing to keep the left from expanding Medicare, Medicaid, and other programs to achieve the same goal.
This reality exposes a problem that must be addressed, sooner or later. The 40-60 million Americans “without health insurance” come from various walks of life, but many are and will use the system without paying for it. The “lack of access to healthcare” is a problem, but the fact that many without coverage will shift costs to the rest of us is a major issue. I don’t favor a purchase mandate, but the current approach encourages free riders. If we are going to provide “emergency” health care to anyone in the country regardless of “ability to pay,” we must come up with a way to require that those individuals pay what they can and use the system more efficiently. This will involve some difficult choices about who has a right to various levels of healthcare without paying for it. Until this issue is addressed, the single-payer crowd will try to exploit it.