There is absolutely no person in America (or anywhere else, but let's stick with the place King is purportedly defending the honor of, for now) who can be guaranteed to not need medical care at any point in their lifetime. Let's suppose for a moment that Steve King can find an example of this no-health-care-ever person in some Somaliesque nook of this nation; there's absolutely nothing saying they won't get hit by a bus tomorrow and ruin that spectacular winning streak. The only way to assure a lifetime of perfect health is to make it self-enforcing, such that you mandate that if they get seriously sick or injured, they just die (which would, you must admit, maintain their perfect no-health-care record.) I suppose you could attach little medical bracelets to the ones who you've decided should be opted out of the system, so that the paramedics or ambulance drivers don't waste valuable time and money patching someone up who had been previously determined to never need patching up. Or something.

The point would be that there are a great many people who think they will never be faced with an illness or an injury. Then it turns out they're wrong. Then we treat them anyway, even if they can't afford it, because at least for the moment we are still not a nation of freaking inhuman monsters who are content to universally let fellow citizens, be they adults or children, die on the curb outside of the emergency room rather than pony up a marginal amount of dough to help them. At least, most of us aren't. Maybe. And that sudden, accidental nature of health care and health problems would be the point of "insurance", and the point of "universal", and would also be a fine reason for what most other not-monsterous nations do, which is have nationwide health insurance of some kind and not try to work out some unholy and ridiculous system by which the insurance companies still run the show but we all pretend we're gonna make them treat us slightly better in exchange for continuing to supply them with their mountains and mountains of private-jet-buying money.

So here's a proposal, and I'd be happy to help Steve King draft this one up so that his conscience can be tucked in more soundly at night and he doesn't have to worry about the nasty government oppressing people. If you can manage to go your entire life without needing one dollar, one dime, or one cent of health care, and never need it to be given to you as charity, let's say that after you die you get all your health care tax money back. Hell, we'll double it. You'll still have the piece of mind of knowing that you've got coverage, even if it does make you probably a communist or something, but after you're dead and your money-grubbing fellow Randian family members have gone through your clothes for loose change, we'll give them a nice, fat check representing all that health care that you never once needed because you had magical anti-ever-needing-health-care powers. Would that be all right? I'd do that.



The underlying supposition of Mr. King's theory is, unfortunately, not limited to Mr. King. It underpins the entire conservative argument to health care reform. In this line of thought, freedom is invoked constantly, but freedom is understood solely as a synonym for greed. The freedom of the healthy, it is presumed, will be abridged if they are taxed even a penny to pay for the less healthy. The freedom of the decently well off will be compromised, it is argued straight-out, we consider it a national interest to care for people those "well off" individuals deem it unnecessary to care for. It could crudely be considered an anti-tax argument, since all anti-tax arguments essentially boil down to some variation of "the nation must provide for me, but I have no intention of providing for it." It couples that rather more banal and commonplace form of greed, though, with something distinctly and explicitly cruel:



[T]he health-care market is not like any other market, as the solicitor general made clear. In no other market are providers of a service required to offer it to anyone who needs it, whether or not the person can afford it. Since 1986, federal law has required that hospitals take care of anyone who comes to them needing emergency treatment, whether or not he or she has insurance or can pay for treatment out of pocket. This is, as Verrilli put it, the “result of the social norms to which we’ve obligated ourselves.” To which Justice Antonin Scalia (a Catholic) replied, “Well, don’t obligate yourself to that.” The implication of Scalia’s remark was chillingly clear: if victims of car accidents arrive at the emergency room without insurance, hospitals must be allowed to let them die on the curb, because that’s what the founding fathers would have wanted.

Consider, then, this question, posed to Verrilli by Justice Anthony M. Kennedy: “Assume for the moment that this”—the mandate—“is unprecedented, this is a step beyond what our cases have allowed, the affirmative duty to act to go into commerce. If that is so, do you not have a heavy burden of justification?” Every premise of that question was a misperception. The involvement of the federal government in the health-care market is not unprecedented; it dates back nearly fifty years, to the passage of Medicare and Medicaid. The forty million uninsured Americans whose chances for coverage are riding on the outcome of the case are already entered “into commerce,” because others are likely to pay their health-care costs.

This is the question being challenged by conservatives, even (or, perhaps, especially) those in seats of supreme power. Is the need for health care truly universal? Or is it merely an option? Justice Kennedy is not known as one of the more frothing members of the court, but even he expresses skepticism at the notion that health needs or the possibility of future health needs are universal necessities. According to this logic, the government would be creating an "affirmative duty" for citizens to engage in commerce, but every last one of those citizens is already engaged in that commerce in both fact and law. The future potential of a need for health care among all living humans would seem to be a self-evident premise, and existing federal law provides that they will be cared for in emergency situations, whether they have preemptively "entered into" that commerce or not. The hospitals and other institutions responsible for that care are already actively engaged in—and mandated to— provide that commerce. There's no opt-out there. There is no citizen who does not benefit from that explicit federal guarantee of some very basic level of care, even if they, like Mr. King's Randian supermen, never actually need to partake of it. They are in that commerce. They benefit from it. They may very well use it next week, or tomorrow, or if they are very unlucky, even in the next twenty minutes.

Once you acknowledge that the "commerce" of care is in fact already universal, then, the only remaining question is how to regulate it. Clearly it can be regulated: there is that extant federal mandate that even private corporations provide a certain standard of emergency care, even without payment, and that seems rather more firm a burden on "commerce" than the federal government usually meddles with. Justice Kennedy's notions of government creating a duty for Americans to enter into certain kinds of commerce (specifically, this kind) would seem to have rather direct precedent already.



It is King's implicit assumption, and Scalia's rather more blunt one, that better presents the far truer (and far, far more regressive) conservative argument. The conservative argument is that there is no underlying right to health care, there is no obligation to provide citizens with that care, and that establishing a tax or fine or program to provide that care is in fact the true infringement of rights and freedoms, as some people might be put out by it. This argument is considered implausible in nearly all other aspects of government: There is no opt-out of defense spending, if you do not wish to pay for it. There is no little box to check if you do not want your tax dollars to go towards transportation spending, or infrastructure improvements, or courthouses, or police forces, or fire prevention efforts. These are decided legal issues. The notion that the rights of a certain small subset of the greedy and amoral are being wounded by requiring them to partake of a federal program to insure all others would seemingly be a rather asinine proposition. For millennial conservatism, however, it is not.

For King, Scalia, and others, the musings are not narrowly targeted to whether the details of a given health care reform law are reasonable: The question posed is whether health care needs themselves are truly universal, or merely optional, and towards this end, the arguments invert themselves so that (as typical of conservative thought, and of the current Congress and Supreme Court in particular) the dollar is the foremost representation of rights and freedoms, and all else is secondary. Do the health care needs of citizens represent "commerce"? If they are "commerce", does not it reasonably follow that we can simply reject those who "commerce" has deemed rejectable? The "right" not to be taxed is being weighed against the "right" of poorer or less fortunate citizens to live, and the outcome of that question is honestly being presumed as debatable, even though there are precious few other contexts in which you could debate the question and not be considered, for lack of a better phrase, a goddamn monster.

That is a rather alarming thought, to say the least. It also explains why the most aggressively conservative wing of Congress and the Court is so set against what would seem to have been as conservative and private-commerce-oriented approach to health care reform as one could possibly come up with. I don't think there is any question—not a damn one—that conservatives would have defended this same law to the hilt if it was George W. Bush that put his name on the bottom of it:

Does Congress have the ability to mandate an action on the part of citizens? Sweet Jesus, that seems an easy one. The conservative viewpoint is that citizens can be "mandated" in and out of Free Speech Zones, states can be "mandated" to uphold the firearm laws of other states, private companies can be "mandated" to engage in domestic espionage even if the Constitution suggested that was probably not a good thing to do.

Does Congress have the ability to delegate a central government function to private industry? Ask that a mere half decade ago, and the very thought would have sent an orgasm shuddering through half of Congress. Our new insurance mandate is premised on exactly that: The notion that government has a duty to provide access to health care for all citizens, but that it will be outsourcing that duty explicitly to for-profit industry. I find that a dubious proposition in the extreme, from a liberal perspective, but it is the sort of thing that Antonin Scalia would be considering perfectly evident in nearly any other possible context (e.g. Social Security privatization.)

The dreaded health insurance mandate is the most corporate-friendly, commerce-friendly, conservative-friendly solution to the problem that could possibly be dreamed up, if you presume health care to be be a universal necessity, and if you presume government has the duty to take steps necessary to secure the lives of their own citizens. What the law is up against, however, is a much more primitive argument. The attacks upon it from conservatives are being based on the rejection of basic health care as a universal need, period, or at very least one that comes in a distant second when balanced against the supposed "freedom" of other citizens to not be bothered with it.

In Mr. King's version, the true victims are the momentarily healthy, not the people who are currently being denied access to the market because they are insufficient vectors for profit. In Mr. Scalia's version, the "victim" is the abstract notion of freedom, a slippery slope in which, if government considers itself to have a mandate to provide universal access to health care to its citizens, there is little standing in the way of it similarly mandating broccoli consumption as well. In neither version is health care for the currently uninsured and/or uninsurable considered a legitimate concern of government. And both versions, it should be pointed out, would even reject the existing notion that citizens must receive emergency room care if it is required to keep them alive. Is that not forcing companies to engage in "commerce" against their will? Is that not forcing fellow taxpayers and health care seekers to engage in extra "commerce" to make up for it?

Of course it is. The chilling part is that the efforts to "defeat" the reformation of health care are, in fact, every bit that regressive. The very concept of health care as universal right or universal duty is being dismissed as folly. It is more prevalent that just that, however: The same contempt for anyone in need finds itself expressed in the budget plans of Paul Ryan, and in the no-tax, all-cut plans of Eric Cantor, John Boehner, and Mitch McConnell, and in the very foundation of the supposed "patriots" of the new and extraordinarily poorly named "Tea Party", and in the omnipresent, incessant one-upsmanship of the Republican presidential candidates. There is no national duty to provide for the sick, or the poor, or the old, or the hungry, and all of those programs can be cut to tatters. The true Freedom lies in the freedom to not give a damn about them; the only true Liberty is one that asks nothing from the rich, and provides nothing to the poor.

If that is what it means to be an American patriot, than I have sorely misunderstood our history. If it is not, than Mr. King, Mr. Scalia and the rest ought to bone up on theirs.

