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Every American already has health insurance; the mandate only requires that he pay for his insurance rather than free-loading on those who do pay. A federal statute and several state statutes require hospitals to provide emergency medical care to people who cannot pay for it, and America’s traditions of compassion mean that doctors will not let people die in pain when they can easily save or help them. In practice, this means that the uninsured will go to costly ER facilities when they need medical help. Congress found that health care for uninsured patients cost $43 billion in 2008; these costs were paid, through higher premiums, by those who do buy insurance.
Congress surely has the power to make people pay for what, out of human decency, the law and practice provide for them.Dworkin makes a very strong case here; I could have pulled any number of quotes from the article supporting the argument for the mandate, whatever you may think of it, being Constitutionally acceptable.
That said, I think we are getting an improved health care system as a result of the ACA. However, it is an improvement on a massive failure by only being a mitigated failure. National health insurance was the correct answer and we missed, I think, an opportunity to get it. What we have instead is, to a large degree, a gift to the insurance companies. [Update: Lawrence O'Donnell makes the case more eloquently than I ever could. ↬ PNHP.org]
I don't think it will be the end of the world if the Supreme Court strikes down the individual mandate. Not-so-secretly, I hope it re-opens the door for us to look at the major overhaul that was our missed opportunity. A ruling against the mandate though will be the end of the myth of an apolitical Supreme Court. Or, it ought to be. That myth really should have died when the Supreme Court effectively installed George W. Bush as President.