Supreme Court proceedings on the legal challenges facing the Patient Protection and Affordable Care Act are over after three days of oral argumentation. But the Court commentary did not end with the proceedings. As the justices are likely to hand down their opinion in June, speculation is rife -- and varied -- on how the decision will lean. Until then, it is worth reflecting on this week's proceedings.
Given my youth, I am first concerned with what seems to be a kind of chasm between young people and the Court. At multiple points in the oral arguments, justices brought up hypothetical examples in which young people would be forced to pay for insurance when they otherwise wouldn't. The assumption here is that we are healthy, so we should not be required to pay the same premiums others must pay. This assumption bothers me in two ways.
Primarily, it is a myth that young folks like myself neither want nor need health insurance. Organizations like Young Invincibles and the Roosevelt Institute | Campus Network are frequently showcasing projects and findings that show the opposite. When we worked together to build and extend a health care toolkit to graduating college students, the response was always positive. If there are young people who don't want or need insurance, we haven't found them. Indeed, Young Invincibles just recently unveiled a their "Meet a Young Person" campaign to debunk these myths.
The second issue with this view of healthful indiscretion is that it mischaracterizes the relationship between health and health care. Often in legal challenges the opponents of health care reform will allege that people should not have to buy health insurance if they are properly healthy, by which it is usually meant these people eat a healthy diet, exercise frequently, and follow a balanced lifestyle. That is indeed a healthy lifestyle; no one would argue otherwise on this point. But the purpose of health care insurance is not redundant with a healthy lifestyle. Health can deteriorate despite good habits in all manner of ways, including accidents, unexpected or unknown conditions, and the loss of income requisite to remain sufficiently healthy. We don't enroll in health insurance solely because we are sick (though that can be the case), but because we recognize the realities of health.
To extend this concern, my next issue with this week's proceedings is that this case was not about health. While Solicitor General Donald Verrilli, Jr. struggled to introduce the realities of health on the ground at the beginning of his argument Tuesday and the end of his arguments Wednesday, a series of questions from the bench and the structure of the oppositions' arguments shifted the discourse toward markets, insurance mechanisms, and legal questions of accountability rather than what it means for millions of Americans to gain previously denied coverage, medical counsel, and treatment.
In some sense this is not surprising. The proceedings are not set up to pull at the heartstrings of justices so much as they are to rigorously debate the conflicting obligations of law. Unless a clear line could be drawn from the human condition under the ACA to the questions of constitutionality, the Court is unlikely to turn on sympathy. For better or worse, the Supreme Court is not Court TV.
How this decision will come down is anyone's guess. Legal scholars and court watchers previously confident in their affirmative prospects for the ACA backtracked from their speculation after the unexpected level of skepticism displayed Tuesday. Those sure that the entire law would be struck down are now unsure given the Supreme Court's perceived hesitance to scour through 2,700 pages of legislation with a surgical scalpel. However the Court turns, we can be sure that this case has lived up to its coverage.
Rajiv Narayan is the Senior Fellow for Health Care Policy at the Roosevelt Institute | Campus Network and a graduating senior at the University of California, Davis.