It’s hard to miss the irony: Mary Brown, the lead plaintiff in the Supreme Court case challenging the health care law, who claimed in court she “doesn’t have insurance” and “doesn’t want to pay for it,” filed for bankruptcy in Florida last fall. Among the debts she and her husband list are $4,500 in unpaid medical bills. No one should be gloating about Ms. Brown’s misfortune. Earlier reports said her family’s auto repair business failed due to the weak economy, compounded by the 2010 BP Gulf oil spill. But her experience shows both why we need the Affordable Care Act, and why the constitutionality of the law should be obvious.
Our modern economy is full of uncertainty. No one knows which businesses will thrive and which will fail. Small businesspeople, to their credit, take a gamble every time they start up an enterprise. That’s part of what makes the American economy so resilient. But even with the best intentions and hard work, you can still run into bad luck. Businesses fail. People get sick. A lot of them end up at the doctor or hospital, and, if they don’t have adequate insurance, they incur some pretty hefty bills.
So what happens if you can’t pay your bills? In Mary Brown’s case, you end up in bankruptcy court to seek relief from your creditors. There is nothing wrong with that, either. We don’t have debtors prisons in America — instead, bankruptcy proceedings give people a chance to clean their financial slates and start over. But just because the bills are discharged doesn’t mean they go away. The doctors and hospitals that Mary Brown owes will have to write off her unpaid bills as a loss or as charity care. Those write-offs get passed along to insurers in the form of higher health care bills, and then on to the rest of us in the form of higher premiums. Four years ago, when fewer people were uninsured, those costs already added over $1,000 to the cost of a family’s insurance premiums.
This connection — between unpaid medical bills and higher premiums for everyone — is not hypothetical. It happens every day, everywhere in the country. And it’s a key reason why Congress enacted the Affordable Care Act, and why it has the power to do so. Mary Brown’s decision not to have health insurance was a conscious economic decision. It left her with health care bills she now cannot pay. Those costs will be passed onto the rest of us. To say that her decision has no impact on interstate commerce, that it’s somehow “inactivity” and therefore not something Congress can affect, as opponents of the law have argued, is to willfully ignore reality.
But you know what Ms. Brown likely doesn’t owe? Thousands of dollars in unpaid broccoli bills. One of the most persistent lines of attack against the Affordable Care Act is that if Congress can require most people to obtain insurance or pay a penalty, they can pretty much force anyone to buy anything, and pretty soon we’ll all be mandated to buy broccoli. But, as others have pointed out, health care is not broccoli. Broccoli expenses are not a factor in 62 percent of bankruptcies; medical bills are. Grocers don’t have to write off the cost of giving away thousands of dollars of free broccoli and pass the cost along to everyone else by jacking up food prices. We all know that’s not how the world works. The market for broccoli works pretty well. The market for health care does not.
Apparently, however, the right-wing politicians who scream that the government is going to force us all to buy broccoli can’t tell the difference between a stalk of broccoli and a hospital bill. The Congress that passed the Affordable Care Act could. That’s why we have an Affordable Care Act, and not an Affordable Broccoli Act. And for the past 75 years, the Supreme Court has followed the principle that it’s up to Congress, not the courts, to figure out what economic markets are working in this country and which ones need intervention. Let’s hope today’s justices follow the same principles. Justice may be blind, but it should still be able to tell the difference between an MRI and a vegetable.
This blog was originally featured in Huffington Post.