The decision by the Supreme Court to uphold the constitutionality of nearly all of President Barack Obama’s health reform plan is ethically very good news. Excluding tens of millions of Americans who had no access to health insurance because they could not afford it or because no one would insure them because they were too sick has long been the single greatest ethical failure of American health care.
The Supreme Court has now affirmed, admittedly on purely legal grounds, that imposing a mandate on each of us to pay for health insurance for all of us can happen. But Obama and the administration cannot become complacent. They still have a huge challenge before them — selling the American people on the morality of insuring access to every American to health care by mandating that we all pay.
Critics of the Affordable Care Act have convinced America that the Obama plan stinks. The government mandate was their best bogeyman in stirring distrust of health reform. They had placed all their chips on a "shock and awe" strategy of having the Supreme Court blow away Obamacare’s mandate in one gigantic negative decision. That did not happen.
The critics will now shift gears and start to fight a guerilla war to chip away at the plan. They will complain about cost, government meddling in the doctor-patient relationship and reopen talk of death panels. The only way to meet these criticisms is for the administration and its allies to do what they still have not done — convince the American people, not of the legality of health reform as happened today but of its morality.
The moral case involves three key arguments. First every American deserves equality of opportunity. The only way to ensure that is to ensure access to basic health care. Just as is true of food and education, you need access to basic health care to compete and flourish in a free market.
Second, no one should go without health care just because they are sick. Excluding people because of pre-existing medical problems is simply immoral.
And lastly if we are a truly a nation, then we have to act like one and bring everyone into access to basic health care by all being willing to pay something for it. Individual rights dominate our political rhetoric. What we need to hear from the President is more about our duties and obligations as citizens to one another.
The Supreme Court has now deemed health reform legal. It is now up to the president to make sure that Americans buy into the argument that it is moral.