J. Scott Applewhite, Associated Press
WASHINGTON — Back when the big health care law was little more than a dream, a prominent figure spoke out against the idea of forcing people to get health insurance. He said that would be like solving homelessness by passing a law making people buy a house.
A step too far. Not the American way.
That was Barack Obama, presidential hopeful. Like every leader and many citizens, he was searching for the right balance between what government should do for people and what people should do for themselves.
His answer on that point changed. But in the United States, the question never does.
A debate that began in the bloody throes of revolution has persisted through history's pendulum swings left and right: the New Deal activism of Franklin Roosevelt, the pushback of Ronald Reagan, the squishy years of Bill Clinton's "third way" and George W. Bush's "compassionate conservatism," the ambitious agenda of Obama.
Then that debate landed in a Florida courtroom, where U.S. District Judge Roger Vinson examined the Patient Protection and Affordable Care Act, marveled at all its moving parts, likened it to a "finely crafted" timepiece and took a hammer to it.
"The Act," he wrote, "needs to be redesigned and reconstructed by the watchmaker." Meaning Congress.
Vinson ruled it was unconstitutional for the government to force people to get health insurance. Never before, he said, has Congress made people buy something "just for being alive and residing in the United States."
The law remains in effect pending appeals and a likely Supreme Court showdown. The judicial scorecard now is 2-2 for and against the law in challenges brought by states. On Wednesday, Senate Republicans took a run at repealing the law, knowing they would almost certainly fail because they lack the votes but determined to put lawmakers on record for or against their effort.
In most other rich countries, it's an article of faith that government will help with health care, just as it provides public education and tightly controls guns. Universal health care programs are a source of national pride despite vigorous complaints about service and cost.
But in the U.S., the unfolding court cases and political donnybrook have made clear that the law, a massively complex instrument that stuffs a dozen acts together and touches every aspect of medicine, hit a simple nerve.
Americans don't yield easily to being told by their government what to do.
They are suspicious that a helping hand will become a heavy hand — that Washington's offer of end-of-life counseling will turn into a federal death panel, that an attempt to control childhood obesity will lead to the feds crushing grade-school bake sales.
Reagan's cry that "government is not the solution to our problem, government is the problem" echoes on one side of the debate.
Even so, Americans elect many Democrats.
They elected Obama, who ran on an agenda packed with hundreds of specific things, large and small, that he promised the government would do.
Indeed, the federal government has been a growing presence in Americans' lives for generations. Due mostly to Medicare and Medicaid, for example, Washington picks up 43 percent of the nation's health bills, a share that the new law is expected to raise only incrementally in the years ahead.
The government makes laws to keep Americans safe from toxic water and air, to ensure baby strollers aren't dangerous and to regulate precisely how many maggots and mites a can of food may properly contain.
Americans might possess a residual frontier mentality, but those pioneers never saw a Social Security check — and woe to any politician who tries to pry that entitlement out of anyone's hands now.
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