I was fortunate to hear Justice Ginsburg’s speech at the ACS National Convention on Friday evening, during which she reiterated her position about the value of dissents (to signal how Congress could change the law [think Ledbetter], and to make a point for historical purposes [think Gonzales v. Carhart]). Of course, everyone in the audience was abuzz that Ginsburg was hinting at a dissent in Florida v. HHS, even though many were Court watchers who know better than to act as Supreme Court soothsayers.
Every day brings more public speculation about the future of PPACA, and everyone seems to be making contingency plans. This phenomenon may speak more to the unpredicability of the Roberts Court than it does to the merits of the arguments. The current Court has been willing to revisit precedent, tweak it, sometimes even overrule it, and such willingness makes outcomes difficult to predict. I also wonder if this speaks to the undertheorization of the Rehnquist Court’s federalism revolution (with nods to Dan and Paul over at prawfsblawg). After all, Lopez is really a summary and categorization of existing commerce power precedent with a traditional state power overlay. The commerce power has a long history of interpretation, including the seminal “plenary power” description from Chief Justice Marshall. But, little tells us how the Roberts Court will read the Commerce Clause.
This is even more true for the spending power question in the case. The spending power is so undertheorized it basically has no theory. The Dole test for conditional spending is merely a Rehnquist-style summary and categorization of prior spending precedent, but none of that precedent provides a theory either, unless you believe the contract analogy from Pennhurst rises to the level of theory. The power to spend also has no early, foundational Marshall interpretation like Commerce or Necessary and Proper. Given that the federal government lacked significant ability to spend until the Sixteenth Amendment was ratified in 1913, the lack of early precedent is unsurprising. But, the first case to provide a heuristic (U.S. v. Butler ) merely affirmed that the Hamiltonian view of the power to spend was correct, that spending is an enumerated power. Not only did that case avoid expressing a theory for interpreting the General Welfare Clause, it went on to limit Congress by the Tenth Amendment, thus arguably producing a self-conflicting result. With no underlying theory, the federalism questions and topic-specific healthcare questions stand on a house of cards.
So, why all the pre-postmortems? Maybe because we still haven’t figured out what most advanced countries did a long time ago – we all do better when we are all well. I was speaking with someone from Scotland recently, and he was befuddled by the fight over achieving universal health insurance coverage in the United States. He asked a question that should have been rhetorical, “Isn’t healthcare a good thing?” If we haven’t decided that healthcare is both essential and good for all of our citizens, then no amount of preparation will facilitate the actual postmortems.