Thursday, March 5, 2015

The ACA Goes to Court (Again)

Yesterday marked the anniversary of our federal government, inasmuch as the Constitution of the United States went into effect on March 4, 1789. That this anniversary receives so little notice each year is itself a symptom of our present political pathology. For the U.S. constitution was intended as a remedy - a strong remedy - for the unsustainable situation (since their separation from the British Empire) that was being caused by sovereignty being invested in the individual states. The constitution created a strong - limited, to be sure, but strong - central government as the ultimate locus of sovereignty.

In an ideal world, I have always believed, the Framers would have completely abolished the states when creating a strong central government. Of course, that option was simply impossible in the political context of the time. The survival of semi-sovereign states was thus guaranteed by circumstances, much as the survival of slavery was. It took a terrible Civil War to undo the compromise with slavery. The federalist compromise survives to this day. 

The current case before the Supreme Court concerning the Affordable Care Act's provision for subsidies for the purchase of health insurance through the so-called "exchanges" is perhaps yet the latest example of the enormous burden the federalist compromise has bequeathed American society. Certainly, the plain sense of the ACA is clearly that it was Congress's intention to facilitate the purchase of health insurance by people who had hitherto been priced out of the health care market. Hence, the exchanges. Hence, the subsidies. Without the subsidies, the exchanges cannot work, and the law fails in its fundamental purpose. Any rational doctrine of legal interpretation should uphold the subsidies to all exchanges - whether set up by states or by the federal government. 

The attempt to derail the ACA on a linguistic technicality reflects the enduring hostility in certain quarters to the idea of universal health care (something simply taken for granted in all other economically advanced societies). I recently heard a young person complain that, unlike gym membership or cable, she didn't see any personal benefit to purchasing health insurance! How typical such a narcissistic, self-centered outlook is in her generational cohort may be an important index of our society's present prospects and future cohesion.

Almost on cue, the liturgy these two days has served to remind us that we are not meant to make it in life as individuals. The reading in yesterday's Office (Exodus 17:1-16) recounted how, during a battle between israel and the Amalekites, Israel's victory was tied to Moses' intercession. This took the physical form of him holding his hands up. Moses' hands, however, grew tired; so they put a rock in place for him to sit on. Meanwhile Aaron and Hur supported his hands, one on one side and one on the other, so that his hands remained steady until sunset. Not even Moses could go it alone. He depended on the support of Aaron and Hur. That is how we are meant to make our way through life - supporting, and being supported by, one another. That's what it means to be human, to be a social being.

Today's Gospel tells the familiar story of Lazarus and Dives (Luke 16:19-31). In the parably, there is no suggestion that the rich man was particularly dishonest or that his wealth was in any sense ill-gotten. His fault is entirely his indifference to Lazarus, the way in which his riches created a barrier between him and his neighbor Lazarus - a barrier of his own making, which at the particular judgment after his death consequently became permanent. It is the perfect illustration of the indifference which wealth makes possible and which Pope Francis has so repeatedly warned the world against.

Bot these familiar stories illustrate a profound fact about human existence, that humans are social beings, and that part of what it means to be part of a society is the acceptance of a responsibility for one another and for the larger whole. To be sure, the ACA is an imperfect , highly flawed instrument in many respects. (We would have avoided a lot of problems with a simpler, single-payer, government plan - e.g., Medicare for all, as President Nixon proposed back in the early 1970s.) But, like federalism and the many other compromises life in the real world requires, it's what we have. 

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