The Supreme Court’s decision upholding the ACA is deliciously ironic. The “individual mandate”–an idea promoted for everyone in the 90s and for Massachusettians (?) in the 2000s by the arm of the Republican party known as the Heritage Foundation–was found to be legal. But not as a mandate, instead as a tax.
Put aside for a minute the dreadful political contortions required to get this quasi-universal health insurance bill past Congress in the first place. Put aside the fact that the supposedly non-political Supreme Court hands down decisions time after time that are a pure reflection of the exceedingly public extreme political views of its justices. Put aside for a minute the fact that the ACA has undeniably kickstarted a round of changes in the health care delivery and insurance system that at least has the potential to lower costs and improve care, and that the luncay of politics meant we nearly lost that momentum.
Instead focus on what the Supremes have done. They’ve cut through decades of rhetoric about how we pay for health insurance and clarified it thus: we pay for health care via taxes–whether they are private taxes on employers and employees (and now individuals) or public ones on citizens.
The–often not observed–principle behind modern taxation is that people (and hopefully corporations) pay according to their ability, and public goods (schools, aircraft carriers, fire engines) are funded with the proceeds of that taxation and distributed according to need. The ACA which has a whole host of redistribution within it does not goes as far towards this principle as I might like, and it still makes certain groups (the elderly, those with middle incomes) pay more than what I’d consider their fair share. But the ruling at least gives us a starting point.
In any rational society health care ought to be a public good financed through taxation and distributed in some manner that makes rational sense. America has never officially believed that. Now it at least has affirmed the concept.