June 29, 2012 | Posted By David Lemberg, M.S., D.C.

There appears to be hope for America, as a society, a democracy, and a nation. On Thursday, 6/28/2012, as everyone knows, the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) by a 5–4 vote. Much was at stake, not the least of which was the possibility of affordable health care for all Americans. But beyond this extremely important outcome, the very nature of our democracy was in play, as well as the potential success or failure of the American political enterprise.

The battle lines had long been desperately drawn, the president’s policies pitted against the avowedly rigid opposition of the red-staters. Sadly for the American public, this to-the-political-death power struggle has played out for almost 4 years and caused the federal legislative process to be effectively frozen in time, glaciated on the day President Obama took office on January 20th, 2009. Remarkably Congress did manage to enact the ACA, but ever since the current House majority has been seeking to tear up the law. The Supreme Court was, as ever, the court of last resort.

The opposition has singularly failed to comprehend that lack of affordable health care causes serious problems for the entire society, not only those almost 50 million Americans on the short end. For example, uninsured patients use hospital emergency departments for primary care, as well as for actual emergencies caused in large part by failure to treat chronic diseases owing to lack of health insurance. The tens of billions of dollars in resultant unpaid fees are, on one hand, absorbed by hospitals which in turn raise their fees to health insurance companies and private patients, and on the other hand, are paid in part by federal and state taxes. In effect, every person who pays taxes and/or purchases health care services and insurance is subsidizing these unpaid emergency room fees. Other hidden costs to society include the loss of human capital, in terms of contributions to the workforce as well as participation in creative activities and innovative ventures. Unwell parents often raise unwell children. The cycle of poor health and low productivity continues from generation to generation. Our society suffers, reflected in the deterioration of our economic welfare, which cascades into degradation (to list but one effect) of our military preparedness and loss of our nation’s ability to project global force to safeguard our interests and our shores.

Lack of affordable health care for every American diminishes our national enterprise in all sectors.

There are other important considerations involved in how the attack on the ACA played out, including the continuing degradation of our use of language. For example, the Supreme Court justices are consistently characterized as “conservative” or “liberal”. This is an immediate problem, as their individual identities are subsumed in the right vs. left dichotomy. But the meanings of the epithets are also lost. To be conservative means to uphold tradition. To be liberal means to uphold progress. However when justices hold their ideologies closely, neither tradition nor progress receive a fair evaluation. As Hannah Arendt states in Between Past and Future, “the very quality of an opinion, as of a judgment, depends upon the degree of its impartiality”. Ideology is not impartial, and Supreme Court opinions have long appeared to be based on politics rather than justice. Obviously, such a state of affairs is a major problem for a democratic society.

But against the odds, Chief Justice John Roberts chose to fulfill his office and uphold justice. The “individual mandate” of the ACA was determined not to have constitutional support as such, but the five-justice majority ruled that the federal government did have the constitutional power to enact the provision as a tax. Both aspects of this decision will have repercussions, but the main point is that the Supreme Court did ultimately rise above political concerns and personal ideologies. In interpreting the Constitution calmly, thoroughly, and appropriately, the Court reminded all Americans of the critical importance of separation of powers. The tripartite division of executive, legislative, and judicial branches of our government is a key linchpin of our democracy. When such separation is muddled, the tyranny of the majority is not far behind. In order for our free society to survive, we each need to broaden our concerns to encompass the welfare of our neighbors and fellow citizens. This may be a naive prescription, but if we fail to think and act beyond our personal prejudices and worldviews, the dream and vision of America will fade and be lost to history, as was the dream and vision of Rome.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.