Georges C. Benjamin, MD, FACP, FACEP (E), is executive director of the American Public Health Association.
I was too young to witness the 1954 Brown v. Board of Education debate in the U.S. Supreme Court. The landmark civil rights case resulted in a unanimous decision declaring the concept of “separate but equal” education in America unconstitutional.
The ruling overturned a 58-year-old Supreme Court decision — Plessy v. Ferguson — that supported state-sponsored segregation in education in our public schools. The plaintiffs in that case were able to show that not only was separate education morally wrong, but it, in fact, fostered an inequality that left minority students challenged in many other ways. Ensuring equal access to a quality education defined not only my educational future but the future of all children.
This week was my opportunity to witness another historic U.S. Supreme Court debate. The justices heard arguments about the Affordable Care Act, a law that reforms our nation’s health system and has taken 100 years to enact. This debate and the opinion reached by the court will be equally as important.
Over the last three days the Supreme Court has heard, what I believe to be, clear and convincing arguments that the law is constitutional in all of its aspects. It should be upheld. They have also heard arguments to the contrary.
The debate was over four major points: The first was whether the fine for not buying health insurance was a simple penalty or a tax and addressed the 19th century Anti-Injunction Act. The second was whether Congress has the authority to require everyone to have health insurance, also known as the individual mandate. The third point addressed the limits of federalism and whether Congress could require states to expand their Medicaid programs as a condition of participation. And the last asked if any part of the law is found unconstitutional, is that part severable, allowing the rest of the law to stand?
This debate has lived up to its billing as a landmark legal case, but it is much more. It will determine for a lifetime the health and economic well-being of our people and, through us, our nation. After all the legal fracas subsides, we’re left to answer several fundamental questions: Will we be a nation that wants a high-performing health system that has everyone in and no one out? Do we want to save the lives of at least 44,000 people — nearly the size of a small city — who die annually simply because they do not have health insurance? Do we want to join the ranks of industrialized nations that see health as a social good worthy of national investment?
Like the debate in 1954, interestingly 58 years ago, the decision is in the hands of nine distinguished judges. This time they get the chance to do the right thing the first time. They should uphold the Affordable Care Act.
Visit APHA’s Supreme Court Case Web page to learn more about the debate.