many people do die, quickly sometimes, sometimes more slowly, of poverty; poverty may be the leading cause of death. Liberty is very often made into a mocking simulacrum by poverty. But I would lay strongest stress on the phrase, ‘the pursuit of happiness'….The possession of a decent material basis for life is an indispensable condition, to almost all people and at almost all times, to this “pursuit.” The lack of this basis— the thing we call “poverty”—is overwhelmingly, in the whole human world, the commonest, the grimmest, the stubbornest obstacle we know to the pursuit of happiness.

-- Charles L. Black Jr.

The Declaration of Independence sets forth the "self-evident" purpose of government -- to secure rights, particularly liberty and the pursuit of happiness. To put forth a "more perfect union," the Constitution was ratified, its functions set forth in its Preamble for all to see; these are the ends for which the federal government was created and a ready guide to better understand the liberties secured therein:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

Thus, it seems readily apparent that Congress has the authority to use its taxation and commerce powers to set forth a national health care policy as it did Social Security and Medicare to provide a more limited security in that area. In fact, as Charles Black Jr. noted in A New Birth of Freedom: Human Rights, Named and Unnamed, it has an affirmative duty to do so. This speaks of a "right."

The Constitution spells out various duties, explicit and implied. For instance, the President has a duty to faithfully execute the laws, even if recent ones did that somewhat in breach. And, without affirmative governmental action, how useful would voting rights be? Or, the right to a civil jury system, one of central importance to smooth run business in this nation? The power to regulate also implies a certain duty to do so. Why else have power over interstate commerce, e.g., if there is not a felt need that this was necessary ultimately to protect our rights?

Some are willing to accept a "human" right to health care (or rather, equitable health care) but not a "constitutional" one as such. A legal right appears to be obligated by our duties to enforce the Universal Declaration of Human Rights, which includes:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

It is to be noted that various state constitutions speak of some duty to provide health care at least to some individuals (e.g., the mentally ill). The courts there apparently leave much to the discretion of the legislature, but this does not negate the duty. As suggested above, there are various rights and duties that are in effect "political questions," or left to statutory laws which the courts would then interpret. This is seen in the context of war power or even "speedy trials," a vague term where it is largely the job of the legislature to fill in details.

And, like education, the right to equitable health care is essential for a full security of various constitutional rights. Is equal citizenship possible if a certain health underclass is in place? If health care is necessary for public well being (and general welfare), should we not provide certain limits to its deprivation? Comparably, deprivation of such necessities like electricity and water should only be done with "due process," including in this context not depriving those with various pre-existing conditions. In fact, given how much public money we already use to subsidize the medical industry, it can be said that we even have a type of "property interest" already in health care, one that warrants equitable provision of it to the population at large. The government is already well involved in providing health care; equitable provision carries this to a fair conclusion.

It is fairly well accepted, up to a point, that we have some personal right, somehow based in the Constitution, to care for our individual health. It is more controversial to argue that there is an affirmative right to get assistance from the government in this department. But, we don't live in a state of nature. Our rights are of little value without the government securing them, at times in an affirmative way. [We have a right to mobility, but without safe and secure streets and roadways, what value is this?] FDR spoke of a Second Bill of Rights for:

We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. “Necessitous men are not free men.” People who are hungry and out of a job are the stuff of which dictatorships are made.

This is as true now and it is then. Rights are not just indulgences, but necessary for the well being of ourselves and our nation. This includes the right to equitable health care. The public is well aware of this and as a whole believes it provides a certain obligation, a duty, one of public morality in fact, for the government to protect its delivery. IOW, a right.

-j

"The Constitution only gives people the right to pursue happiness. You have to catch it yourself."

Ben Franklin

As for the General Welfare Clause...the constitution then goes on to define all the the rights along with Provide for the Common Defense. As I understand the constitution, those rights not specifically enumerated to Congress lie with the states. Public healthcare is not a federal responsibility....

But, be careful of what you ask for. Dependence on the government can create a tyranny just as quickly as a hungry mass can allow for a tyranny be made.

"Dependence begets subservience and venality, suffocates the germ of virtue, and prepares fit tools for the designs of ambition."
Thomas Jefferson

Don't think the fed can impose it's will once it starts paying the total sum of healthcare? Federal highway funds are an excellent example of the fed imposing it's will, and supported by the USSC. The precedent is set. Once the fed is footing the bill for healthcare....you don't think that at some point they will begin to tell you what you can and can' t do for risk of your healthcare bills? They already do.

I can't agree with you that it's a right....a moral obligation, maybe. I would have an easier time digesting the idea if I actually saw enough people that gave a shit about taking care of themselves and not just interested in the financial aspect of healthcare. It's the benjamins that seems to be the concern here.....healthcare is really just a convenient vehicle for the people to vote themselves more money. Meanwhile...we will continue to eat and smoke our way into pre-existing conditions and chronic disease.

Point is....healthcare isn't the driving factor here....cost is. Your argument that it is a right is bollocks. It wasn't a right 230 years ago any more than it is a right today.... It's a personal responsibility before it is anything. You are free to live with the choice you made....until you vote in Uncle Sam to make the choice for you.

You make an interesting point about health care 230 years ago. The fact is that health care back then was so rudimentary that there was no real long term care for cancer. There weren't MRIs or xray machines. The costs associated with health care would never rise above what someone made. In fact, insurance didn't cover health care until some time in the late 40s or early 1950s.

The biggest problem with your desire to keep our current system is that we compete against other countries that are getting a break because their costs are lower than ours and those costs are spread out over their entire population.

As I understand the constitution, those rights not specifically enumerated to Congress lie with the states. Public healthcare is not a federal responsibility....

This begs the question. The Tenth Amendment:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

If, as I argued, the Congress has a clear power and responsibility to handle this matter, particularly via the taxation and interstate commerce power (health care is a major national industry as is health insurance), it does not "lie with the states." Also, where is the word "specifically?" In fact, the word was particularly not put there -- the Congress has the power to pass laws "necessary and proper" to carry out its tasks. To the degree states handle this issue, they too have constitutional responsibilities. The 14A says it must act in an equitable matter. I do wonder if you think Social Security and Medicare is unconstitutional too.

You speak of "dependence." Better to be sick and die than that! Better to be dependent on private health insurance corporations than the government, the latter elected by "we the people," that former by a select few in the promotion of profit, not "general welfare." Suffice to say, the dependence is there already. It is a question of who should ultimately safeguard us.

I also don't know what "moral obligation" means. If someone is "obligated" to me, I have a "right" to demand something from them. As to placement of blame, do those who are are uninsured or underinsured only amount to the slothful? Governmental health care, including periodic visits and such, if anything might advance preventive care and good health habits. This is seen by governmentally subsidized immunizations and health education.

I will remind those sick of the "choice" they made to not have the luck to have avoided a pre-existing condition or who has gone bankrupt because of the cancer they received only from sloth or birth defect their child has received.

-j

I sometimes hear reference to this & don't exactly see the point.

Any given matter might have been simpler or in a more primitive state at that time. In Star Trek times our medical care will seem primitive. Also, people went broke from illness and injury then as well. Such accounts can be found in Dickens type fiction. Health insurance also might not have been as broadly available, but it was available to some before then.

You are quite right to reference the pragmatic problems with lack of reform. Pragmatics and the moral path often are connected, as I suggested at the end of my first post.

-j

Yes....it is better to be sick and die than to give up hard earned freedoms. You haven't sacraficed a damned thing for them....so understandably, they don't mean so much to you....until you don't have them. Understand one thing....what the government gives, it can also take away. While they foot your bill, they have the power over you. The fed already imposes this power on States. It's not a far stretch for the fed to impose it's will on you once you have given them the power of paying your bills and covering your ills. And guess what....it will be against the law for you to opt out. If you want free housing and healthcare, go to jail.

Dependency on private health insurance is still an option....from what Obama says, this won't be an option if his plan is adopted.

I sure as hell don't want it if I can't walk away from it.

Those other nations also have a healthier populace because they live different lifestyles than us too. They aren't simply healthy because their health coverage is free..... No amount of doctor visits is going to get someone off their ass unless they're supervised or learn from a young age. So...if taking care of ourselves is something that needs to be learned....we should be teaching this in school....not paying for some couch potato that just ate themselves into diabetes. Again....the push is for lower healthcare costs.....for us. Not because we need it....we've just figured out how to vote ourselves money....and will kill our republic in the process.

You write as if the status quo was a viable solution. Look at the numbers, in a couple of years we will be at 20% of GDP for health care, numbers that the country cannot sustain. If we dont reform the current system, we will drop into the 3d world hell hole category in a few years.

First, do you think Social Security and Medicare is unconstitutional? It would help clarify things.

Second, how do you know what I or any one particular person sacrificed to protect our freedoms?

Next, health care corporations already have power over you. You seem to fear the government as if it is some dangerous force vis-a-vis the corporations, though only one is in place by our votes. Only one is not driven merely by profits. Only one has the mandate to protect the community at large, not only the profits of their shareholders. And, you can opt out of Medicare now. Why you think you will be forced to only go to one particular health plan is unclear. The preferred path is a public option ... it gives you more choices.

Finally, it is not "free" ... even a national health service is not "free." People pay things called "taxes," even the poorest paying some such as sale and use taxes.

-j

"The Constitution only gives people the right to pursue happiness. You have to catch it yourself."

Ben Franklin

Equitable health care helps you pursue happiness a lot better. In fact, few (if any) truly obtain happiness. Some even believe that only comes after you die. Life is but a journey, a pursuit.

-j

Joe: I'll answer -- yes Medicare and Social Security are probably unconstitutional. They only were allowed to exist because one Supreme Court Justice, Owen Roberts, chose to change his vote on the meaning of the general welfare clause in Butler v. U.S. in 1937. Roberts made this decision under the political pressure from FDR, who was threatening to "pack the court" with judges, because SCOTUS kept striking down the various New Deal programs. Before Butler, SCOTUS felt that "general welfare" did not mean the country could exceed its enumerated powers.

That had been the prevailing legal viewpoint since the writing of the Constitution. Madison, who wrote the Constittution, said this about "general welfare." "With respect to the two words "general welfare," I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators."

If you can show that the provision of health care is among the enumerated powers, then fine, proceed. I don't see it in the general welfare clause, nor is it hiding behind the "necessary and proper" clause -- Congress is empowered by that clause only to do the things necessary and proper to accomplish the enumerated powers. Powers not delegated to the federal government by the Constitution belong to the states, or to the people.

I understand the fear of corporations, but when it comes to insurance companies, I can always walk away from them -- I can go without insurance entirely, or buy from a different company. I won't be able to walk away from a government-run program. I'm stuck with it -- in fact, if Obama's statements over the weekend are true, not only would I be stuck with it, I'd be forced to participate, and fined for failure to do so. That this lack of choice is being defined as freedom strikes me as rather Orwellian.

Your reference to the couch potato and diabetes is silly. Our costs are far higher than in other countries. That means that products made here are forced to up their prices to cover it. You currently subsidize the health care for employees that work for companies where they provide insurance. What is the difference if you pay more for your car because the manufacturer pays for insurance or if you pay higher taxes and goods made here are cheaper?

We currently pay for unpaid E/R bills. There are funds that hospitals submit bills to if they are for service to people without insurance. What ever they can't recover that way they pass on to us in the form of higher charges.

Do you have a solution in mind or are you in favor of leaving things as they are?

I have yet to state that healthcare needs to maintain status quo. My bitch is with the fed taking it over....I have a hard time with that. I feel it's a step backward in regards to the founding of this nation and an affront to freedom.

Yes, I can't argue against that healthcare is ridiculously expensive. I can't argue against the fact that there are and will always be unscrupulous business dealings....and the government is by far not immune. Profit and power go hand in hand....both are just as corrupting as the other. To actually think that if the government ran our healthcare system, it would be better is flat out naive and/or ignorant of our elected officials past. Government and efficiency are a paradox....they aren't in the business of making money, and are quite liberal with how they spend it. The only thing that will change is whose pockets get lined.....I would rather a corrupt businessman than a corrupt politician.

Considering most of the worlds medical research goes on in the United States...it stands to show why it would be cheaper in foreign lands...research is an expensive endeavor. Shall we stop finding new solutions? This will define progress for you? You seem willing to give up freedom and progress so you can save a buck....I don't really think you give a damn if someone else saves a buck. If we were to pay for free healthcare and health education for all our children....but the adults will still have to pay their own way as before.....would that be an equitable solution for you?

I still think the fed needs to keep itself out of this business....even if it was for the betterment of our childrens health. I don't believe creating a generation of kids that were raised on entitlements will do much for the protection of our freedoms or our bottom line.

That is consistent & underlines the outlier nature of the argument. In for a penny, in for a pound, I say. Others are not, and I cry foul.

FDR managed to deliver his ends the old fashioned way -- old justices retired and the new ones accepted the changing understanding of what was constitutionally allowed, a view convincing enough that top legal minds on the Court already accepted it on various matters. Not to speak of those off the Court. Thus, talk of "packing the Court" only suggests things were sped up a bit.

The immediate power, and this points to New Deal legislation over unions too, is smoothly regulating interstate commerce. The importance of regulation of health care and insurance -- including taxing those who don't have it & thus skewers the pool (and causes various other costs when they get sick) -- in this respect is more direct than any number of federal occupation and safety rules. Thus, the taxation power applies to "general welfare" broadly and in a more narrow respect. Not to speak of the fact that I don't know what Madison would think given the test of time; he changed his views on the constitutionality of the bank given that.

As I said upfront, I also think that various rights of citizenship are not properly secured without certain governmental protections. This too gives the government, the feds in certain ways, the power to regulate in this area as well.

If someone shoots you or you get cancer, you will not just lay down and die, even if you don't have funds to pay for insurance. Those with kids etc. also don't (in the real world) have all these "choices" either. Likewise, the public option allows you to choose a non-governmental policy. To the degree that this won't happen, it will be stupid, but it doesn't rob Congress of the authority to regulate the right way in this area. And, the private insurance will be heavily regulated as well, so in no way truly "private" anyway. Still, somehow, we manage to have a police department ... some, I guess, rather just have a private service there too. Or, maybe fire departments. Once upon a time, such was the case.

I am not supporting any specific policy here either, so I don't really care what Obama said (anyway, if we accept what we are told, it seems what he wants and thinks Congress is willing to pass is not the same thing, so Congress -- or certain members there -- are the ultimate concern). Given reality now, Orwell would find your side more fitting of the term, methinks.

-j