Opinion

vpHealthcare-Analysis-Gallery

Why not just cut open a goat and be done with it? In ancient Rome, a special kind of priest called a haruspex would "read" the entrails of sheep to divine the will of the gods, the health of the growing season, or whatever else was weighing on the minds of men. Because animal guts don't, in fact, impart that much information about, say, next year's wheat harvest, the haruspices (called "auspices" in Latin -- from which we get the English word) could pretty much make it up as they went along. The same went for the auguries (priests who studied the flight of birds). Ultimately, the auspices and auguries made their decisions based upon the whims, vicissitudes and demands of politics in one form or another. If the rulers were happy with the result, they didn't much care what the guts actually said. 
 Fast-forward to chief haruspex John Roberts. 
 In the majority opinion written by Roberts, the Supreme Court held that the mandate to buy health insurance under the Affordable Care Act (aka ObamaCare) is unconstitutional under the Commerce Clause and the Necessary and Proper Clause. But Roberts also found that it's constitutional under <a href="/topics/U.S._Congress">Congress</a>'s power to tax. It is on these grounds that Roberts upheld the constitutionality of ObamaCare, siding with the four liberal justices of the bench. 
 The upshot is that <a href="/topics/U.S._Congress">Congress</a> cannot use the Commerce Clause to force you to eat broccoli, but it can tax you into doing so. Huzzah for liberty! To reach this decision, Roberts had to embrace a position denied by the White House, <a href="/topics/U.S._Congress">Congress</a> and vast swaths of the legal punditocracy: that the mandate is a tax for the purposes of constitutional consideration but not a tax according to the Anti-Injunction Act (which bars lawsuits against taxes until after they're levied). Roberts' effort, wrote Justice <a href="/topics/Antonin_Scalia">Antonin Scalia</a> in dissent, "carries verbal wizardry too far, deep into the forbidden land of the sophists." Let the record show that the sophists were valued defenders of entrail-reading. 
 Of course, there are substantive arguments in favor of Roberts' reasoning. But as far as I can tell, no one is confident, never mind certain, that Roberts actually believes his own position. And among supporters of ObamaCare, from the White House on down, no one cares whether he does. 
 <a href="/topics/Barack_Obama">President Barack Obama</a> -- self-praised constitutional scholar -- mocked those who called the fees and penalties under Obamacare a tax. Now he celebrates a decision that mocks him back. <a href="/topics/Democratic_National_Committee">Democratic National Committee</a> executive director (and former White House aide) Patrick Gaspard seemed to summarize the depth of concern on his side of the aisle when he responded to the ruling on Twitter: "It's constitutional. Bitches." More sober-eyed liberal legal experts took similar positions. Roberts' opinion was "statesmanlike," they claimed, and, more bizarrely, "apolitical." 
 Some, such as constitutional scholar <a href="/topics/Jeffrey_Rosen">Jeffrey Rosen</a>, speaking on <a href="/topics/NPR">National Public Radio</a>, even celebrated Roberts' brilliance at finding a way to save the reputation of the court by deploying what Thomas Jefferson called "twistifications." Indeed, before and after the ruling, much of the journalistic and legal establishment argued that a 5-4 ruling to overturn Obamacare would be "political" because the majority would be comprised entirely of <a href="/topics/U.S._Republican_Party">Republican</a> appointees. But a 5-4 ruling to uphold Obamacare would be apolitical because, well, it just would be. 
 In other words, if five conservative justices rule according to their well-known convictions, it's illegitimate. But if Roberts twists himself like an illustration in the Kama Sutra to find a way to uphold the law, then that amounts to "leadership." Now, I don't know what's in Roberts' heart, but no court watcher I've heard from puts much weight on the idea that Roberts did anything other than reason backward from the result he wanted in order to buy respect from the court's critics at the expense of his own beliefs. 
 At least that's one thing both fans and critics of this ruling can largely agree on. 
 Some of Roberts' defenders claim he's outmaneuvered everyone. By upholding Obamacare, he's made future conservative decisions unassailable. He's poisoned the well of the commerce clause for liberals. He's removed the court as an election-year issue. 
 He's gift-wrapped for <a href="/topics/Mitt_Romney">Mitt Romney</a> the attack that <a href="/topics/Barack_Obama">Obama</a> has raised taxes massively, violating a host of promises and assurances. And, again, he's saved the legitimacy of the court. 
 That's all very interesting, but it leaves aside the real issue: None of those concerns are what was asked of the court. That so few people seem to care augurs poorly for the rule of law and the auspices of our republic. 
 <a href="/topics/Jonah_Goldberg">Jonah Goldberg</a> is editor-at-large of National Review Online and a visiting fellow at the <a href="/topics/American_Enterprise_Institute">American Enterprise Institute</a>. You can write to him by e-mail at JonahsColumn@aol.com, or via Twitter @JonahNRO.

Commentary

OPGOLD29

Goldberg: John Roberts' judicial 'twistifications' on health care

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The Supreme Court's decision is in. With the Affordable Care Act mostly intact, tens of millions of uninsured Americans will gain coverage. Senior citizens will get billions of dollars of prescription drug benefits. Everyone with insurance will get preventive services at no cost. Roughly 60,000 people now covered by the new Pre-existing Condition Insurance Plan will still have that coverage, even though they are actually sick and thus might actually use it. We all still have the guarantee that our policies won't be canceled when we get sick. And our adult children can stay on our health plans until they're 26. 
 The bullet we just collectively dodged would have caused pain throughout the country, with women taking the hardest hit. That's because women stand to gain the most from the health law. We are already getting improved benefits under the Affordable Care Act - things like mammograms, pap smears and immunizations for our kids, which insurers have been required to cover without a co-pay since last year. And in just over a month, on Aug. 1, women will have the same unfettered access to <a href="/topics/Diabetes">diabetes</a> screenings (men too, but women are more negatively impacted by the disease), annual well-woman visits, HPV testing, domestic violence screenings, breast-feeding support and, after much wrangling, contraception. 
 Even more is on the horizon, of course. Though the decision left new room for states to wiggle out of expanding their Medicaid programs in 2014, millions of uninsured women will still likely gain coverage this way, when states are made to include everyone with incomes below 133 percent of the federal poverty level. Also, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating. 
 Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur - and perfectly legal - to deny us coverage in the private insurance market because we have had <a href="/topics/Breast_Cancer">breast cancer</a> or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition. 
 All this made women more likely to be uninsured - as one in five women under 65 were in 2010. And even when we did have coverage, we often weren't able to get our insurers to pay for birth control and other basic prevention (even while they were doling out <a href="/topics/Viagra">Viagra</a>, no questions asked). 
 Many mothers stayed in full-time jobs they didn't otherwise want because they provided them, and their kids, with health care. Shameful bogus "maternity insurers" sprung up to exploit the very real desperation of pregnant women who couldn't find care in the individual market. And because many health plans lacked abortion coverage, some women even resorted to do-it-yourself abortions. 
 And then came the Affordable Care Act. Years after other rich nations figured out how to provide all their citizens with decent health care, we were finally heading there ourselves. Had the court decided to reverse that progress, women might have remained stoic. Given our years spent taking the greed and unfairness of the insurance industry on the chin (and uterus), you might think we'd just soldier on with our benefits returned to their former pathetic level. 
 But I don't think so. While this decision is a victory for the <a href="/topics/Barack_Obama">Obama</a> administration, it should also come as a relief to the very Republicans who mounted the challenge -- and surely would have been the objects of wrath had they stripped these basic, humane gains from the millions of women and other Americans who are already benefiting from them. 
 Writer Sharon Lerner is a senior fellow at Demos, a policy research organization, and the author of "The War on Moms: On <a href="/topics/Life_%28show%29">Life</a> in a Family-Unfriendly Nation." She wrote this for slate.com.

OPLERN29

Lerner: Women gain most from Obamacare

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WASHINGTON -- It's the judiciary's Nixon-to-<a href="/topics/China">China</a>: 
 Chief Justice <a href="/topics/John_Roberts">John Roberts</a> joins the liberal <a href="/topics/Wing_%28musician%29">wing</a> of the Supreme Court and upholds the constitutionality of Obamacare. How? By pulling off one of the great constitutional finesses of all time. He managed to uphold the central conservative argument against Obamacare, while at the same time finding a narrow definitional dodge to uphold the law -- and thus prevented the court from being seen as having overturned, presumably on political grounds, the signature legislation of this administration. 
 Why did he do it? Because he carries two identities. Jurisprudentially, he is a constitutional conservative. Institutionally, he is chief justice and sees himself as uniquely entrusted with the custodianship of the court's legitimacy, reputation and stature. 
 As a conservative, he is as appalled as his conservative colleagues by the administration's central argument that Obamacare's individual mandate is a proper exercise of its authority to regulate commerce. 
 That makes congressional power effectively unlimited. Mr. Jones is not a purchaser of health insurance. Mr. Jones has therefore manifestly not entered into any commerce. Yet <a href="/topics/U.S._Congress">Congress</a> tells him he must buy health insurance -- on the grounds that it is regulating commerce. If government can do that under the Commerce Clause, what can it not do? 
 "The Framers ... gave <a href="/topics/U.S._Congress">Congress</a> the power to regulate commerce, not to compel it," writes Roberts. Otherwise you "undermine the principle that the Federal Government is a government of limited and enumerated powers." 
 That's Roberts, philosophical conservative. But he lives in uneasy coexistence with Roberts, custodian of the court, acutely aware that the judiciary's arrogation of power has eroded the esteem in which it was once held. Most of this arrogation occurred under the liberal Warren and Burger courts, most egregiously with Roe v. Wade, which willfully struck down the duly passed abortion laws of 46 states. The result has been four decades of popular protest and resistance to an act of judicial arrogance that, as Justice <a href="/topics/Ruth_Bader_Ginsburg">Ruth Bader Ginsburg</a> once said, "deferred stable settlement of the issue" by the normal electoral/legislative process. 
 More recently, however, few decisions have occasioned more bitterness and rancor than Bush v. Gore, a 5-4 decision split along ideological lines. It was seen by many (principally, of course, on the left) as a political act disguised as jurisprudence and designed to alter the course of the single most consequential political act of a democracy -- the election of a president. 
 Whatever one thinks of the substance of Bush v. Gore, it did affect the reputation of the court. Roberts seems determined that there be no recurrence with Obamacare. Hence his straining in his Obamacare ruling to avoid a similar result -- a 5-4 decision split along ideological lines that might be perceived as partisan and political. 
 National health care has been a liberal dream for a hundred years. It is clearly the most significant piece of social legislation in decades. Roberts' concern was that the court do everything it could to avoid being seen, rightly or wrongly, as high-handedly overturning sweeping legislation passed by both houses of <a href="/topics/U.S._Congress">Congress</a> and signed by the president. 
 How to reconcile the two imperatives -- one philosophical and the other institutional? Assign yourself the task of writing the majority opinion. Find the ultimate finesse that manages to uphold the law, but only on the most narrow of grounds -- interpreting the individual mandate as merely a tax, something generally within the power of <a href="/topics/U.S._Congress">Congress</a>. 
 Result? The law stands, thus obviating any charge that a partisan court overturned duly passed legislation. And yet at the same time the Commerce Clause is reined in. By denying that it could justify the imposition of an individual mandate, Roberts draws the line against the inexorable decades-old expansion of congressional power under the Commerce Clause fig leaf. 
 Law upheld, Supreme Court's reputation for neutrality maintained. Commerce Clause contained, constitutional principle of enumerated powers reaffirmed. 
 That's not how I would have ruled. I think the "mandate is merely a tax" argument is a dodge, and a flimsy one at that. (The "tax" is obviously punitive, regulatory and intended to compel.) Perhaps that's not how Roberts would have ruled had he been just an associate justice, and not the chief. But that's how he did rule. 
 Obamacare is now essentially upheld. There's only one way it can be overturned. The same way it was passed -- elect a new president and a new <a href="/topics/U.S._Congress">Congress</a>. That's undoubtedly what Roberts is saying: Your job, not mine. I won<a href="/topics/Charles_Krauthammer">Charles Krauthammer</a> is a syndicated columnist for The <a href="/topics/Washington_Post_Company">Washington Post</a>. His email address is letters@charleskrauthammer.com.

OPKRAU29

Krauthammer: Why John Roberts upheld Obamacare

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NEW YORK -- To paraphrase Democratic former House Speaker <a href="/topics/Nancy_Pelosi">Nancy Pelosi</a>, the Supreme Court had to rule on "Obamacare" -- the Affordable Care Act -- so we could find out what's in it. 
 In an opinion that defied all predictions, the nation's highest court judged Obamacare constitutional. Swing vote <a href="/topics/Anthony_Kennedy">Anthony Kennedy</a> did not join his liberal colleagues. Instead, conservative pinup <a href="/topics/John_Roberts">John Roberts</a> flew with the court's left <a href="/topics/Wing_%28musician%29">wing</a>. Among the pundits who paraded through TV studios before Thursday's decision, none saw this coming. 
 Writing for the 5-4 majority, Roberts agreed with Obamacare's free-market critics that <a href="/topics/U.S._Congress">Congress</a> cannot compel people (via the individual mandate) to purchase a product (health insurance) to regulate these Americans. Insofar as the court restrained <a href="/topics/U.S._Congress">Congress</a>' ability to deploy the commerce clause to such ends, it likely limited future mischief by professional troublemakers on Capitol Hill. 
 However, Roberts and Democratic-appointed Associate Justices <a href="/topics/Stephen_Breyer">Stephen Breyer</a>, <a href="/topics/Ruth_Bader_Ginsburg">Ruth Bader Ginsburg</a>, <a href="/topics/Elena_Kagan">Elena Kagan</a> and Sonya Sotomayor decided to justify Obamacare's individual mandate as a tax. This truly is head scratching, as the mandate's costs were marketed as a penalty, not as the new individual mandate tax. 
 By letting the Obama administration proceed stealthily along a route it avoided publicly, Roberts and his four new buddies resemble cops who have stopped a motorist for speeding. When the driver explains that he was going 85 mph to enjoy his new transmission, the police officers reply: "Well, that would be illegal. But since you're late for work and want to keep your job, please floor it and get out of here." By allowing the mandate to survive as a tax, Roberts and the court majority have handed <a href="/topics/Barack_Obama">President Barack Obama</a> a major victory -- and two major headaches (more on that later). 
 This clearly is a massive relief for Obama. Had Obamacare been rejected outright, he would have had to face voters with virtually zilch to show for his tenure. His $828-billion stimulus has stimulated nothing. Designed to keep <a href="/topics/Unemployment">unemployment</a> below 8 percent, it instead presaged 40 consecutive months of joblessness at or above that level -- the worst such performance since 1948. 
 Cash for Clunkers merely shifted demand for automobiles earlier on the calendar, yielding no long-term <a href="/topics/Benefit_%28designer%29">benefit</a>. Some $5.1 trillion in fresh <a href="/topics/US_National_Debt">national debt</a> (up 48 percent since he arrived) has delivered feeble GDP growth of 1.9 percent. 
 Obama's sole triumph -- the much-appreciated and highly worthy Navy SEAL shooting of <a href="/topics/Al-Qaeda">al-Qaida</a> chief <a href="/topics/Osama_bin_Laden">Osama bin Laden</a> -- now drowns beneath a <a href="/topics/Niagara_Falls">Niagara Falls</a> of national security leaks. One blabbed detail, among many, outed a doctor who helped locate bin <a href="/topics/Osama_bin_Laden">Laden</a>. His thanks for helping American intelligence: a 33-year sojourn in a Pakistani prison. 
 Rather than run for re-election beneath a banner stating, "I got nothin'," Obama will brag endlessly about his signature accomplishment. 
 Still, Obama faces two potential <a href="/topics/Migraines">migraines</a>: First, the Supreme Court unwittingly has placed Obama's greatest hit on a collision course with one of his biggest promises. "If your family earns less than $250,000 a year, you will not see your taxes increased a single dime," Obama told a joint session of <a href="/topics/U.S._Congress">Congress</a> on Feb. 24, 2009. "I repeat: not one single dime." By sticking with Obamacare, Obama must admit that he has stuck Americans with a new tax on nearly everyone, not just the "millionaires and billionaires" whom he decries by day and with whom he dines by night at $40,000 per plate. America's Spender-in-Chief now seeks another term as the Taxer-in-Chief. 
 Second, according to pollster Scott Rasmussen, 54 percent of likely U.S. voters want Obamacare repealed. Those numbers will go up, not down, as citizens realize that this 2,801-page monstrosity is an unworkable, bloated, Washington power grab turbocharged by a near-universal tax hike. 
 None of that rhymes with "four more years!" To paraphrase <a href="/topics/Forrest_Gump">Forrest Gump</a>: The Supreme Court is like a box of chocolates -- you never know what you're going to get. 
 Deroy Murdock is a columnist with the Scripps Howard News Service and a media fellow with the <a href="/topics/Hoover_Institution">Hoover Institution</a> on War, Revolution and Peace at Stanford University. Email Deroy.Murdock@gmail.com.

OPMURD29

Murdock: Court win will give Obama headaches

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You can go ahead and cue the talk of “repeal and replace,” but it’s important to understand that the slogan is merely Republican sound and fury, and signifies nothing. 
 To repeal the Affordable Care Act, Republicans in Congress would need far more than a majority. In fact, Republicans in the Senate would need far more than the 60 votes they currently require to perform the seemingly simplest of tasks. These days, you can’t declare Ottumwa, Iowa, a “generally groovy place” in the Senate without 60 votes. 
 For Congress to put in place new legislation that President Barack Obama opposes, and will veto at the speed of light, both the House of Representatives and the Senate would have to override that veto with two-thirds majorities. Both chambers, either before or after the upcoming elections, are more likely to declare theme sessions on the floor that include “Nude Mondays,” “Thirsty Thursdays” and “Godless Fridays” than they are to achieve those kinds of majorities against Obama. 
 Regardless of what any conservative luminary says, there is absolutely no chance in the next few years that Congress can overturn this law. As for presidential candidate Mitt Romney’s assertion that he will stop this program on day one if he is elected (a very busy day in the imagination of any serious presidential candidate), that may be a bit more credible. If the past few years have shown us anything, it’s that the executive privilege of the president is powerful, slippery and hard to define. Romney, if elected, would oversee federal agencies that must implement this law, and he could do a lot to slow it down, even if he is the man, in Massachusetts, who pushed the same law through. 
 But when senators and representatives say they’re going to put the kibosh on Obamacare, ignore them. It just isn’t in the cards. 
 Pictured Above: Health Care Act&nbsp;opponents wear masks of U.S. President Barack Obama and the grim reaper as they demonstrate in front of the U.S. Supreme Court. (June 28, 2012).

Filler: "Repeal and replace" not going to happen

Filler: "Repeal and replace" -- it's not going to happen

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A deeply divided Supreme Court did with <a href="/topics/Barack_Obama">President Barack Obama</a>'s health care act what high courts are supposed to do: It brought a sharp and conclusive end to the debate over whether the Affordable Care Act was constitutional. 
 By a 5-4 vote, the justices said it was, with Chief Justice <a href="/topics/John_Roberts">John Roberts</a>, usually numbered among the conservatives, joining what's loosely described as the "liberal" <a href="/topics/Wing_%28musician%29">wing</a> of the court to write the majority decision. This long-awaited ruling -- the law was passed and immediately challenged in early 2010 -- may mark the moment that the panel truly became the "Roberts court." Arriving at the decision could not have been easy. Swing justice <a href="/topics/Anthony_Kennedy">Anthony Kennedy</a> wrote in dissent, "In our view, the act before us is invalid in its entirety." The majority dealt quickly and cleanly with the thorniest point of the law, the mandate requiring individuals to buy health insurance or pay a penalty, by brushing aside the arcane debate over the Commerce Clause and simply declaring the mandate a tax and, as such, well with the government's power to impose. 
 The ruling was a clear victory for <a href="/topics/Barack_Obama">Obama</a> as the election campaign escalates and an undoubted morale boost for a White House that has been battered by bad news and missteps. 
 <a href="/topics/U.S._Republican_Party">Republicans</a> immediately announced plans to push ahead with their mantra "repeal and replace," but that may not be as easy as it sounds. Take away the name "Obamacare," a pejorative among the <a href="/topics/U.S._Republican_Party">GOP</a>, and polls show that parts of the law are truly popular with <a href="/topics/U.S._Republican_Party">Republican</a> rank-and-file: -- Allowing young adults to stay in their parents' insurance until age 26. 
 -- Ending annual and lifetime limits on health insurance payouts. 
 -- Not allowing children with health problems to be denied insurance. 
 -- And, by 2014, not allowing people with pre-existing medical conditions to be denied coverage. 
 And then there are the sheer numbers: The law enables 30 million Americans who don't have health insurance to get it and the administration estimates only 4 million people will reject that <a href="/topics/Benefit_%28designer%29">benefit</a>. The law excludes illegal immigrants. 
 "Repeal" will be tough, "replace" even harder. The House <a href="/topics/U.S._Republican_Party">Republican</a> alternative of vouchers to buy health insurance, even under its new name "premium support," has not caught on with voters. And then there is the awkward fact that the Affordable Care Act closely parallels <a href="/topics/Mitt_Romney">Mitt Romney</a>'s own plan as <a href="/topics/Massachusetts">Massachusetts</a> governor. 
 The administration did suffer one serious setback. The law greatly expands Medicaid -- medical coverage for the poor and disabled -- to cover another 17 million, but the court struck down a provision that revokes all of a state's Medicaid funding if it refuses to go along with the expansion. 
 The idea of national health care has been taken up by at least eight presidents going back to Teddy Roosevelt. And now, thanks to Thursday's ruling, the country has such a plan. 
 Dale McFeatters is a senior writer for the Scripps Howard News Service.

OPMCFE29

McFeatters: Affordable Care Act is law of the land

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WASHINGTON -- The political impact of Thursday's stunning Supreme Court decision on health care reform is clear -- good for <a href="/topics/Barack_Obama">President Barack Obama</a> and the <a href="/topics/U.S._Democratic_Party">Democrats</a>, bad for Mitt <a href="/topics/Mitt_Romney">Romney</a> and the <a href="/topics/U.S._Republican_Party">Republicans</a> -- but fleeting, and thus secondary. Much more important is what the ruling means in the long term for the physical and moral health of the nation. 
 All but lost in the commentary about the court's 5-4 ruling, with Chief Justice <a href="/topics/John_Roberts">John Roberts Jr.</a> unexpectedly joining the majority, is that the Affordable Care Act was intended as just a beginning. We have far to go, but at least we're on our way. 
 <a href="/topics/Barack_Obama">Obama</a>'s great achievement is not any one element of the health care reform law -- not even the now-upheld individual mandate compelling individuals to have health insurance or pay a fine. The important thing is the law's underlying assumption that every American, rich or poor, should have access to adequate health care. 
 In the rest of the industrialized world, this simple idea is taken for granted. When <a href="/topics/Barack_Obama">Obama</a> took office, however, about 50 million Americans lacked health insurance. Many low-income families, especially the "working poor" who make too much money to qualify for Medicaid, were faced with impossible decisions: Take a sick child to the doctor or pay the rent? Buy medicine or buy groceries? 
 Those who cannot afford health insurance do ultimately receive care, of course -- but often in hospital emergency rooms, where treatment is much more expensive than in a doctor's office. Our system is thus both callous and extravagant, costing much more than it should while delivering substandard results. 
 The <a href="/topics/World_Health_Organization">World Health Organization</a> gives the U.S. health system an overall ranking of 37th in the world, far below other Western democracies. The <a href="/topics/Central_Intelligence_Agency">CIA</a> World Factbook -- hardly the work of a bunch of left-leaning one-worlders -- reports that life expectancy in the United States is not just lower than in other industrialized countries but also lower than in <a href="/topics/Jordan">Jordan</a> and <a href="/topics/Bosnia">Bosnia</a>. Infant mortality in this country, according to the <a href="/topics/Central_Intelligence_Agency">CIA</a>, exceeds that of Slovenia and Cuba. It is possible to quibble with these figures but not to ignore them. We should be ashamed of ourselves. 
 Most working-age Americans who have health insurance obtained it through their employers. But this is a haphazard and inefficient delivery route that puts U.S. businesses at a disadvantage against foreign competitors, most of which shoulder no such burden. Tying health insurance to the workplace also distorts the labor market and discourages entrepreneurship by forcing some employees to stay where they are -- even in dead-end jobs -- rather than give up health insurance. 
 For healthy individuals, it is crushingly expensive to buy insurance on the free market. For those with pre-existing medical conditions, it is essentially impossible -- but not for long, thanks to the Supreme Court's landmark ruling. 
 Rather than seek a radical reshaping of the health care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured -- about 30 million -- but still not all. He also tried to use free-market forces to "bend the curve" of rising costs, slowing but not halting their rise. 
 The result -- the Patient Protection and Affordable Care Act -- is a huge, complicated, unwieldy piece of legislation. I would have loved to see the president try for something simpler and more elegant, perhaps a "Medicare for everyone" single-payer system. Maybe that's where we'll end up someday. 
 But despite all the rhetoric we'll hear from Romney and the <a href="/topics/U.S._Republican_Party">GOP</a> until Election Day, health care reform is here to stay. Provisions such as guaranteeing insurance coverage to those with pre-existing conditions are too consumer-friendly to be taken away; and once these new measures take effect, which happens in 2014, insurance rates would rise sharply -- and unacceptably -- without the individual mandate. 
 And medical costs will continue to soar, despite the law's efforts to contain them. Inevitably, if only because of deficits and the <a href="/topics/US_National_Debt">national debt</a>, <a href="/topics/U.S._Congress">Congress</a> will have to revisit the health care issue with an eye toward more radical changes. 
 When that next big push takes place, it will be with the underlying assumption that health care should be available to all who need it regardless of their ability to pay -- that it is not a privilege but a right. Progressive presidents since <a href="/topics/Theodore_Roosevelt">Theodore Roosevelt</a> have tried to enshrine this principle. <a href="/topics/Barack_Obama">Barack Obama</a> did it. 
 <a href="/topics/Eugene_Robinson">Eugene Robinson</a> is a nationally syndicated columnist for The Washington Post. His email address is eugenerobinson@washpost.com.

OPROBI29

Robinson: Health care, the bigger picture

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WASHINGTON -- The Supreme Court's decision upholding the health care law is not only a huge victory for <a href="/topics/Barack_Obama">President Barack Obama</a>, but also a moment of leadership for Chief Justice <a href="/topics/John_Roberts">John Roberts</a>. The court's mixed verdict could create problems, notably in its weakening of the law's Medicaid provisions in the name of states' rights. While the impact of this part of the ruling is not fully clear yet, the court may have effectively denied health care coverage to a large number of poorer Americans. 
 But the headline victory for the law was of enormous importance to <a href="/topics/Barack_Obama">Obama</a>. Had the court knocked down the Affordable Care Act, all the spin in the world could not have undone the damage that would have been inflicted on the president and his political standing. Thanks to this ruling, the broad structure of the largest domestic achievement of the <a href="/topics/Barack_Obama">Obama</a> legacy remains intact. It gives him bragging rights in the campaign, and in history. And for those who support universal coverage, the fact that the law remains on the books offers an opportunity to build on it in the future. 
 And Obama was wise to use his address to the nation on the court's decision to restart the effort to explain what the Affordable Care Act actually does and the benefits it offers to Americans who already have health insurance, those who are worried about losing it, and those who would like to get it but cannot now afford it. By putting the health care law at the center of the news, the court case gave the president and other supporters a second chance to do what they should have done more effectively in the first place. It was a nice touch for Obama to try to turn the law's low rating in the polls to his <a href="/topics/Benefit_%28designer%29">benefit</a>. "It should be pretty clear by now," he said, "that I didn't do this because it was good politics." He was also smart to speak briefly, and to avoid triumphalism. 
 But if it was Obama's day, the day also belonged to Roberts. Ever since he took the helm at the court, Roberts' critics -- and I have certainly been a vociferous one -- have seen him as failing to live up to the implicit promises he offered during his confirmation hearings to a brand of judicial moderation. 
 This decision is not as clean and clear as it should have been. But by spearheading a plurality opinion that at least recognizes the power of <a href="/topics/U.S._Congress">Congress</a> to legislate on an important social and economic problem, Roberts avoided the far shoals of conservative ideology. He sought to avoid a direct confrontation with the executive and legislative branches. 
 Roberts' rulings on <a href="/topics/Citizens_United">Citizens United</a> and a variety of labor and regulatory issues fed fears that he would happily take on the role as the leader of a right-<a href="/topics/Wing_%28musician%29">wing</a> judicial revolution -- and there is still reason to worry that this is exactly what he'll do on many other issues, notably <a href="/topics/Affirmative_Action">affirmative action</a>. But on health care, Roberts chose to blunt these attacks. He cast himself as a jurist sensitive to the obligation of the courts to at least some deference to the government's elected branches on matters of social policy. He took what might have been a center-left decision upholding the entire law and nudged it to the center or center-right. What he did not do -- and this is to his credit -- was join the right end of the court that wanted to gut the act. 
 Still, it is disturbing that the court, including Roberts, appears to have weakened the law's provisions that sought to use Medicaid to push states to help to insure many more Americans. Medicaid is a federal law giving the states a great deal of federal money. There is no entitlement to this money. It seemed reasonable for the federal government to use a federally created program to push for the national goal of providing health insurance for all Americans. Before liberals heap praise on Roberts and conservatives declare him a sellout, both sides need to come to terms with the meaning of this part of the ruling. 
 Overall, it was a good day for <a href="/topics/Barack_Obama">President Obama</a> and for Chief Justice Roberts. And with the court so closely divided, it also underscored the importance of the judicial appointments that the president elected (or re-elected) this November will make. We are, it turns out, still one vote away from total conservative dominance on judicial questions. And this is why the health care law survived. 
 <a href="/topics/E.J._Dionne">E.J. Dionne</a> Jr. is a syndicated columnist for The Washington Post. His email address is ejdionne@washpost.com.

OPDION29

Dionne: A win for Obamacare -- and Roberts

john roberts obama cropped

For the past month, the media frenzy surrounding the United States Supreme Court has reached a fever pitch. So many citizens and politicians have been sitting on pins and needles awaiting the court's decision on the Affordable Care Act that there's been an unusual amount of drama at the end of this year's term. 
 The court doesn't announce in advance which cases will be decided on any given day. With the exception of the justices, their clerks and a handful of officials in the court's publications office, the news breaks only once the justices begin reading. So for the past few weeks, it has come down to a guessing game on the morning when decisions are scheduled to be announced. 
 On a Monday morning several weeks ago, a cable television anchor announced live on the air, with apparent certainty, that the court would announce the health care decision that day. That morning the courtroom was full of spectators, many lining up early to get one of the couple hundred seats for the public. The room buzzed with excited whispers until a Supreme Court marshal cautioned the audience to keep quiet. 
 There was also a larger than normal contingent in the court's press gallery that day. Outside, at the foot of the court's steps, a bank of television cameras and microphones was set up in anticipation. 
 But only one opinion came down that day -- and it was so uninteresting there was a <a href="/topics/Subtle_%28musician%29">subtle</a> collective sigh in the press gallery. The media story became not that day's decision, but that the health care ruling had not come down -- which led to a few more weeks of speculation over what this meant. 
 Was it a close call? Were the justices still divided? Would each justice write an individual opinion? Would the court hold over the decision until the next term? 
 So for more than a month, the story about the health care case became the story of how the court was not announcing the decision. This complicated legal issue -- the subject of six hours of oral arguments -- boiled down to a simplified tale about delay and the politics of the decision. 
 The case's widespread public interest reopened the discussion on cameras in courtroom. The Supreme Court justices have steadfastly fought against broadcasting their proceedings. Some say the public wouldn't understand the complexities of the cases, that lawyers would grandstand to the cameras during arguments or the public would get a skewed understanding of proceedings because the media focuses on sound bites. 
 But even without cameras in the Supreme Court, the court actually operates with a ton of openness. All the briefs are open to public scrutiny; the arguments, complete with the justices' questions, are done in open court in front of an audience; the opinions are read in open court and published for all to read. 
 The Internet has also opened much of this to the public as well. The court's opinions are made available to the public within minutes of their reading via the website. The Supreme Court's website also posts transcripts of the oral arguments, usually within hours of the arguments. Technology has facilitated this public access to the court and, in turn, the public's understanding of the law. 
 Credible Internet sites -- such as Scotusblog.com, which transmits a live blog of the announced readings and then posts the opinions online -- have made the court's workings accessible to wider audiences, too. Months ago, only a few thousand court watchers followed the happenings on Scotusblog. As the court released its decision today, the site reported more than 800,000 live readers. 
 So while the television reporters do their live stand-ups at the foot of the Supreme Court building, and the newspapers and online journalists rush to be the first to report the opinions, the public has a real chance to get a clearer picture of what the court has done and how it once again has defined the law of the land. 
 Roy S. Gutterman is an associate professor and director of the Tully Center for Free Speech at the S.I. Newhouse School of Public Communications at Syracuse Universtiy.

OPGUT28

Gutterman: The Court itself becomes the story

147335824

Barack Obama made a bold, all-in bet last fall when he asked the U.S. Supreme Court to rule on the constitutionality of his signature health care law in the thick of the presidential campaign. 
 It was best for the nation to have the legal questions hanging over the controversial law resolved before the November election. But for Obama, it was a high-stakes gamble that the court wouldn’t eviscerate the law -- and in the process, hand ammunition to fevered critics branding him a radical willing to trash the U.S. Constitution in pursuit of some fanciful, socialist utopia. That would have been a devastating blow to his reelection campaign. 
 He won big today when the court ruled that the Affordable Care Act is constitutional. 
 Of course Obama’s reelection is far from assured. Republican candidate Mitt Romney can now tell voters who don’t like the law that electing him is their only hope of killing it. 
 And the mandate in the law that almost everyone buy insurance or pay a fine survived only because the court ruled that penalty is really a tax — a word Obama avoided like the plague when fighting for passage. And the law’s expansion of Medicaid to cover millions of the uninsured took a hit when the court said Washington couldn't take away existing federal Medicaid funding from states that refuse to sign on. 
 But this was a big one for the president.

Bessent: Obama's high-stakes gamble

Bessent: Barack Obama's high-stakes gamble on health care

"The bottom line: the entire ACA is upheld." That's what SCOTUSBlog wrote moments after the Supreme Court announced its ruling on the health-care law. But it wasn't upheld in the way most thought it would be. The decision was 5-4, with Chief Justice <a href="/topics/John_Roberts">John Roberts</a> siding with the Court's liberals, and Justice Anthony <a href="/topics/Anthony_Kennedy">Kennedy</a> casting his vote with the conservatives. 
 This will be covered, in many quarters, as a political story. It means <a href="/topics/Barack_Obama">President Barack Obama</a> -- and Solicitor General Don Verrilli -- are popping the champagne. It means that <a href="/topics/Mitt_Romney">Mitt Romney</a> and the <a href="/topics/U.S._Republican_Party">Republicans</a> who were fighting the health-care law have suffered a setback. It will be covered in other quarters as a legal story: It is likely to be central to Roberts' legacy, and perhaps even to how we understand the divisions in the Court going forward. 
 And, to be sure, it's all those things. But those stories don't capture the effect this decision will have on ordinary Americans. 
 The individual mandate, by bringing healthy people into the insurance market and lowering premiums, means health insurance for between 12.5 million and 24 million more Americans than if the mandate was struck down. And as Kennedy said in his dissent that the conservatives on the Court believed the entire law should have been invalidated, it means health insurance for 33 million more Americans than if Kennedy and the conservatives had their way. 
 Those are big numbers, But behind them are real people. People like Eric Richter. 
 Richter, a 39-year-old resident of <a href="/topics/Ohio">Ohio</a>, works at a stone drilling company. He and his wife made $36,000 a year. That's too much to qualify for Medicaid, but too little to easily afford insurance. So Richter didn't purchase insurance. "It's hard to pay for the unknown, when you're struggling to cover the known," he told Sabrina <a href="/topics/Sabrina_Tavernise">Tavernise</a> of the <a href="/topics/New_York_Times_Company">New York Times</a>. "I know it sounds irresponsible, but that's just the way it was. It's a game of roulette you hope you're going to win." Then Richter discovered a tumor growing up his leg. He first tried home remedies, cutting out sugar and eating beets, having read somewhere that it might help. But it kept growing. His wife sewed him new pants to accommodate the "melon-sized" lump. 
 He stood in church, because it was too painful to sit down. He was turned away from a needed scan because he lacked insurance. In April, doctors in the emergency room told Richter his tumor was malignant. His wife desperately tried to find an insurer would would cover them. No one would. The tumor was, of course, a pre-existing condition. 
 Perhaps nothing in Richter's story speaks to the cruel reality of the American health-care system better than this: Richter's wife, Dani, was recently let go from her job at an electronic records firm. For most families, this would be a tragedy. For the Richters, it might be a lifesaver. The loss of income pushed them well beneath the poverty line, and that might mean they qualify for Medicaid. "We're back to crossing our fingers," Mrs. Richter told Tavernise. 
 Richter has had some good luck, too. A doctor eventually took an interest in his <a href="/topics/Case_Western_Reserve_University">case</a> and helped him get surgery. The family, however, still has no idea how they will pay the bill for the surgery, or for his needed follow-up care. 
 The passage of the Affordable Care Act means that, come 2014, people like the Richters get guaranteed health care coverage. If their income is less than 133 percent of the poverty line, they receive Medicaid (unless their state rejects federal Medicaid dollars for the expansion, something the Court made it easier for them to do). If their income is between 133 percent and 400 percent, they receive some level of subsidies. At $36,000, the Richters would be paying less than $200 a month, and no insurer can turn them away. If they are now below the poverty line, they get Medicaid, no questions asked. 
 There is uncertainty between here and 2014. In particular, Mitt <a href="/topics/Mitt_Romney">Romney</a> could win the election and repeal the law entirely, meaning none of the 30 million Americans expected to gain coverage under the law get it. 
 But the particular roulette wheel that began spinning when <a href="/topics/U.S._Republican_Party">Republicans</a> took to the courts to invalidate the Affordable Care Act has come to a stop. And the Richters have won. They can finally uncross their fingers. 
 Ezra Klein writes for The Washington Post.

OPKLE28

Klein: A victory for Barack Obama -- and the Richters

I was in the office of a co-worker about 10 minutes after it became clear the Affordable Care Act had been upheld and she said, “I’m actually way more excited about this than I imagined I would be.” 
 I think that’s a fairly widespread reaction, and I don’t think it has much to do with health care. 
 It has to do with the fact that for the first time in almost 20 years, the nation changed something big in the hope it would make the United States a better place. And it’s been a very long time since that happened, in a conservative or liberal way. 
 Think about it: What was the last big, significant change the federal government made in how things work? I can’t come up with anything major since President Bill Clinton and Congress implemented welfare reform in 1996. 
 After Barack Obama won the presidency in 2008, a fair number of people, although they didn’t vote for or support his policies, said they felt positive about the fact that he won the office. It felt good just to know we had become a country that could elect a black man to its highest office when, 50 years earlier, such a man might not have been able to eat a meal in a restaurant or sit at the front of a bus. 
 There are a lot of real problems in Obamacare. The funding, in particular, is based on two things that may never happen: cutting Medicare reimbursements to doctors, which the Congress has failed to do each year since 1997, and reducing the profit that private companies make on Medicare Advantage (and Washington isn’t always great at taking away profits from the corporations that, well, donate to the campaigns of politicians). 
 But gracious, it feels good to know we could potentially, possibly, on a great day, when the wind is right and the sun shines, do big stuff. Maybe we could even build infrastructure, bridges and roads and such. Maybe we could fix education, or get renewable power industries going, like wind and solar. Maybe we could rebuild a manufacturing base, or, yes, make our people healthier, and thus happier. Maybe we could deal with immigration, and rejigger Social Security to make it solvent, and figure out Medicare funding. 
 There are a lot of people, and some days I’m one of them, who believe Obamacare is the wrong thing to do. But even that, somehow, doesn’t feel as bad as being a citizen of a country that can’t do anything. &nbsp;

Opinion: America can still do big things

Filler: America can still do big things

Today’s stunning ruling, in which Chief Justice John Roberts joined the court’s four more liberal members to devise a way to make the Affordable Care Act constitutional should really not come as a surprise. Not if you take a step back from today’s political rhetoric and realize that the court is the branch of government that must take the long view. 
 The chief justice, while an equal among nine, also institutionally and personally carries the responsibility to preserve the reputation of the court. And Roberts, who clerked for the late Chief Justice William Rehnquist, one the most conservative justices in court history, is always cognizant of the delicate balance the court must maintain. 
 The great irony is that the many of the prominent&nbsp; Democrats praising the ruling today&nbsp; voted, as U.S. senators against the confirmation of&nbsp; Roberts as Chief Jusitce in 2005. The list includes President Obama, Secretary of State Hillary Cinton as well as Charles Schumer,&nbsp; Harry Reid of Nevada and Richard Durbin of Illinois. 
 This is what Roberts wrote, a primer on the roles of each branch of government: “Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.” 
 While Roberts was unable to deliver a majority opinion in this very complex case, he did find a way to honor conservative principles but not thrust the court into the middle of a vicious political and policy debate that would only tar it as well. His plurality opinion is a deft compromise by a court that realizes the danger of usurping the power of Congress, especially to overturn a law that, while very flawed, is the result of decades of discussion, indeed started by Richard Nixon, about how to reform the nation’s insurance system for health care. 
 So he crafted a strategy that found that Congress and President Barack Obama went too far in extending the commerce clause to require individuals to purchase health insurance. This the broccoli argument — that if you upheld this health care law, the federal government could require you to not only eat broccoli, but buy a Prius and use CFL light bulbs. The decision Thursday supports that populist argument. 
 But Roberts saved the law by siding with four liberal justices to find that the requirement of buying insurance was really a tax. And, as a tax, Congress had the power to impose it. 
 It wasn’t that much of a stretch. The law is written as a tax, as any penalty would be reported on an individual’s tax returns and would be paid to the IRS. It’s just that Democrats and Obama — dishonestly and unfortunately — didn’t want to call it that for partisan political reasons. 
 It is, however, one of the arguments the administration made in court. And, it was a question by Justice Sonia Sotomayor that might have sealed the deal for Roberts. Sotomayor asked Paul Clement, the highly regarded attorney for the 26 states seeking to overturn the health care act, whether it would be permissible for the court to call it a tax, one that people who had insurance didn’t have to pay. 
 “The government might be able to do that,” said Clement, who won universal praise for having turned in a better performance than Donald B. Verrilli Jr., the solicitor general, during the hearings. 
 That answer was exactly the open door Roberts needed to craft a ruling that honored the individual liberty argument, but didn’t gut the law. 
 Roberts, of course, is not the only justice to realize the significance of the case to the court itself. Even the dissents, on first read, are muted and much less vitriolic that ones earlier in the week in the Arizona immigration ruling. 
 The immediate outcome of this case is disappointing to many for political reasons. Even the law’s supporters are concerned about the difficulty of how it will work when all the provisions go into place. Pundits are tripping over themselves trying to decide whether this helps Obama’s re-election chances or boosts Republican candidate Mitt Romney. Who knows? 
 But if you take the long view — the view the chief justice inevitably had to take — then it was the Supreme Court that won today. 
 Pictured Above: The U.S. Supreme Court &nbsp;

John Roberts and the Supreme Court won today

Supreme Court Health Care cropped

So what does the Supreme Court’s upholding of the Affordable Care Act mean to New Yorkers? Not nearly as much as it does to people in other areas of the country. 
 New York is one of eight states (the others are Connecticut, Hawaii, Vermont, Iowa, North Carolina, Oregon, Maine) that passed 10 major protections outlined in Obamacare into state law. These protections would have held in the Empire State regardless of what the Supreme Court did. 
 They are: * Plans cannot drop patients once they get sick * No refusal to cover children with pre-existing conditions * No annual coverage dollar limits * Plans must provide access to OB/GYN care * Plans must cover birth control on the same basis as men’s health care * Plans must cover preventive care with no co-pays * The insured can choose their primary care doctors and pediatricians * Plans can’t contain lifetime coverage limits * Plans must provide access to emergency care with no approvals needed * Parents must be able to keep young adults on their plan to age 26 
 In addition, the Medicaid expansion called for under the new federal health care rules will have far less effect on New York, with its very liberal and extensive Medicaid coverage, than it would in states with more restrictive programs. 
 The biggest changes for New Yorkers are these: They will be required to purchase health insurance if they can afford it, or pay a fine if they choose not to, and insurance won’t be able to turn down coverage for adults, even when they have pre-existing medical conditions. 
 More will become clear as the law is detailed and implemented, but those are the big headlines for New Yorkers at the outset. 
 Pictured Above: Brianny Abreu, 6, has her vitals checked at the William F. Ryan Community Health Center in New York.

Viewsday: How the Court's ruling effects New Yorkers

Filler: How the Supreme Court's health care ruling affects New Yorkers

Well that was close. 
 As everybody no doubt knows by now, the Supreme Court upheld the centerpiece of President Barack Obama's health care reforms, validating the constitutionality of its requirement that everyone carry health insurance or pay a penalty that the court said is really a tax. This "individual mandate" started life as a pretty good Republican idea, but became radioactive to the GOP when Obama took it up. It's more or less the same system Mitt Romney put in place in Massachusetts, where it works fairly well. 
 In my view it would be far better to cover everybody under Medicare and call it a day. I'd even hoped that, if the Supreme Court struck down all or most of Obamacare, we'd get to a single-payer system sooner. 
 But for all its warts, the complicated and ill-understood plan that Obama and the Democrats have given us is what we're stuck with, and it's a lot better than no plan at all. Most of America's 46 million uninsured will be covered, thanks in part to government subsidies for those who can't afford insurance on their own. People who've had cancer or some other serious disease will no longer be shut out of the insurance market. Amen. 
 Opponents of the plan ought to bear in the mind that it's not the big deal they seem to think it is. Government at all levels already covers about half of U.S. health care spending; the economist <a href="http://american.com/archive/2011/august/the-government-share-of-health-care-is-bigger-than-advertised-health-fact-of-the-week">Christopher Conover</a>, for instance figures that, taking account of tax breaks, governments pay for 53 percent of our medical costs. We also way outspend any other country in the world on a per capita basis or as a proportion of gross domestic product, even though we fail to cover everybody. It's a tragic fact that nearly every American under age 65 faces the risk of bankruptcy from medical bills, or death from lack of care -- a situation that prevails in no other comparable nation, to my knowledge. 
 These are the big issues: overspending, poor health outcomes, no coverage at all for millions, and insecurity for all. The Obama plan won't solve all of these problems -- not by a long shot -- but it's way better than nothing. Bad enough that American health care is a mess. It needn't also be a shame.

Akst: Health care still a mess, not a shame

Akst: After court decision, health care is a mess, but not a shame

CANDIDATES CAPTION - HEALTHCARE

So the Patient Protection and Affordable Care Act — aka Obamacare — has now passed the ultimate legal scrutiny. 
 By a narrow 5-4 decision, the Supreme Court has ruled that not only is the controversial mandate that all Americans must purchase health insurance fully constitutional, but so are all the plan’s other parts. The one notable exception is that the federal government cannot withhold funds from states that refuse to expand Medicaid according to Obamacare’s dictates. 
 We now know what it feels like when the Supreme Court decides what has universally been called “the single-most important decision” in the past 10, 25, 50 or even more years (I know, because I’m pretty sure I used all those time counts and more in covering the health care reform issue over the past two years). 
 As someone who opposed the law, I can say it doesn’t feel especially good. But here’s an unsettling truth that should temper bitter resentment, unrestrained ecstasy and any mix of feelings at today's outcome: The Supreme Court almost never changes the course of history. 
 It might speed up or slow down the direction in which we're headed -- and lord knows, it's made some genuinely terrible decisions over the years -- but the role the Court plays is mostly to certify social, cultural and political trends, not to start them. 
 When the Court signed off on constitutional protections for legal segregation in the odious 1896 decision Plessy v. Ferguson, it was tragically mirroring where the majority of Americans were regarding separation of the races. The same was true when the Court decided Brown v. Board of Education in 1954, which ended the practice. Even the hugely controversial 1973 decision, Roe v. Wade, which gave protections to abortion rights, was following a pronounced shift in attitudes toward abortion and the legalization of the practice in several states. 
 One of the few recent major cases where the Supreme Court appeared to be ahead of the curve was 1997's Reno v. <a href="/topics/American_Civil_Liberties_Union">ACLU</a>, which tossed out most of the Communications Decency Act, a law with huge bipartisan support that would have effectively regulated the Internet like a broadcast network. The law would have strangled the nascent World Wide Web in the name of protecting children from unseemly online content. 
 As the Georgetown constitutional scholar Mark Tushnet has told me, "The Court can have some influence on the margins, pushing things a little further in the direction that they're already moving or sometimes retarding the direction." The bottom line, though, is that the Court is rarely if ever the prime mover in anything. As Tushnet figures it, "10 years down the line, the society's going to be pretty much where it would've been even if the courts hadn't said a word about it." 
 None of this is to say that the Court can't make better or worse decisions, or ones that are more popular or less popular. The 2005 decision Kelo v. New London, for instance, sanctioned governments to use <a href="/topics/Eminent_Domain">eminent domain</a> under virtually any circumstance, prompting a huge backlash at the state and local level to greatly narrow when elected officials might seize property for the so-called public good. 
 The plain fact is that the Supreme Court is never the last word on anything. Its justices "may not read the headlines," in the sense that they follow public opinion closely, but the court itself is generally a lagging indicator of what's really happening in the country. That's an insight that should give some succor to today's losers -- and temper the enthusiasm of today's victors. 
 Nick Gillespie is the editor in chief of Reason.com and ReasonTV and the co-author "The Declaration of Independents: How Libertarian Politics Can Fix What's Wrong with America."

OPGILL28

Gillespie: Despite media hype, Supreme Court rarely changes history

vphealth

WASHINGTON -- Calculating who will write the final decision of the Supreme Court's term is a game that usually interests only a small band of lawyers, professors, reporters and politicos who obsess over the justices' every footnote. 
 But this year, the likelihood that Chief Justice <a href="/topics/John_Roberts">John Roberts</a> is preparing the court's judgment on <a href="/topics/Barack_Obama">President Barack Obama</a>'s health-care overhaul is worthy of headlines and a whirl of Internet spin. 
 Roberts's questions at oral arguments are being consulted, his decisions in past cases are being reviewed, and the analysis is under way about whether his presence in the majority means he is preparing a life preserver or a stake for the Affordable Care Act. 
 The first Monday in October and the last week of June, the bookends for each session, are always moments in the spotlight for the Supreme Court. But this is no ordinary time. 
 The court has rarely occupied so prominent a place in the public consciousness as now: deciding the constitutionality of a health care plan that would touch every American, ruling on the president's bitterly fought signature domestic achievement, issuing an opinion that will immediately affect election-year politics. 
 "More people have paid attention to this case than any other case in recent memory, probably with the exception of Bush vs. <a href="/topics/Al_Gore">Gore</a>," <a href="/topics/Paul_Clement">Paul Clement</a>, who argued the case on behalf of the law's challengers, told reporters last week. 
 But that decision, which decided the 2000 presidential election, was an anomaly, an emergency that no doubt sealed the court's reputation for many but was unlike its usual practice of briefing and argument and contemplation and opinion-writing. 
 Health care, <a href="/topics/Paul_Clement">Clement</a> said, "is a case where everybody from ordinary citizens to reporters who are not <a href="/topics/The_Used_%28musician%29">used</a> to covering the court are getting an education in how the court works." The main way it works, of course, is in secrecy, beyond public view and in a place unlike much of official Washington. 
 Television cameras are not allowed. The lucky spectators admitted to the courtroom are told to check their BlackBerrys at the door. Reporters are discouraged from using noisy cellphones, even in the press room. Ornate metal gates block the marble stairways that lead to the justices' chambers. 
 Unlike many other institutions in this city, the court sticks to a sharp timetable, and the decision will be delivered Thursday morning, shortly after 10 o'clock. And unlike in the rest of leak-happy Washington, discretion is demanded above all else. The health care case was probably decided soon after the court's historic three days of hearings in March. But even now, only a few dozen court employees -- half of whom are probably unhappy with the decision -- know the outcome. 
 <a href="/topics/Paul_Clement">Clement</a>, who was solicitor general under President <a href="/topics/George_W._Bush">George W. Bush</a>, said people unfamiliar with the court, especially political reporters, cannot believe that the result has not been disclosed. 
 "The thing I've found most amusing is their complete inability to believe there will not be leaks," <a href="/topics/Paul_Clement">Clement</a> said. "They are so <a href="/topics/The_Used_%28musician%29">used</a> to covering the other two branches of government that they just assume leaks are absolutely inevitable." Absent those, Monday's gush of news from the court, on its penultimate day of decisions, provided much fodder. 
 When Justice Anthony <a href="/topics/Anthony_Kennedy">Kennedy</a> was announced as the author of the opinion on <a href="/topics/Arizona">Arizona</a>'s restrictive immigration law -- the court's second-most-significant case of the term -- that provided a clue that Roberts would be writing the health care ruling. 
 Roberts and Kennedy are thought to hold the balance of power on the case, and it would be unlikely that Kennedy would write both. 
 The court delivered a split decision in the <a href="/topics/Arizona">Arizona</a> case, upholding the most controversial provision of the law with a sort of "we'll be watching" warning and striking three others -- and prompting immediate speculation. Could the ruling provide a template for a health care compromise? Could the justices, for instance, strike the health care law's unpopular insurance mandate and still find a way to make the overhaul work? Monday's session provided another lesson for those who were there to witness it. The justices regularly declare themselves to be warm and caring colleagues, shaking hands before each session and proclaiming that harsh words are never spoken in their private conferences. 
 But things can look different on the bench. Justice Elena <a href="/topics/Elena_Kagan">Kagan</a> announced the court's decision that states may not impose mandatory life sentences without parole for juvenile killers. Then the justice to her immediate right, <a href="/topics/Samuel_Alito">Samuel Alito</a>, was moved for the first time in his career on the court to object from the bench. 
 He dressed down the logic of the opinion -- and its endorsement of what he called an elitist attitude -- that overturned what he said should be a prerogative of the states. 
 <a href="/topics/Barbara_Perry">Barbara Perry</a>, a Supreme Court expert at the Miller Center at the <a href="/topics/University_of_Virginia">University of Virginia</a>, was in the audience. "You could just hear the emotion in his voice," she said. 
 Kagan, the newest justice, had not quite mastered the art of staring impassively ahead. 
 There was more. Justice Antonin <a href="/topics/Antonin_Scalia">Scalia</a> ripped the court's immigration ruling, with an unexpected criticism of <a href="/topics/Barack_Obama">Obama</a>'s decision to ease deportation of illegal immigrants who were brought to the country as children. 
 "The president has said the new program is 'the right thing to do' in light of <a href="/topics/U.S._Congress">Congress</a>'s failure to pass the administration's proposed revision of immigration laws," Scalia said. "Perhaps it is, though <a href="/topics/Arizona">Arizona</a> may not think so." Perry thought it was a "gratuitous shot," adding that she felt the same when <a href="/topics/Barack_Obama">Obama</a> criticized the court during the <a href="/topics/State_of_the_Union">State of the Union</a> address in 2010. 
 A former Supreme Court fellow who worries about the institution, she is distressed by polls that show growing public dissatisfaction with the court and an increasing number of people who think its decisions are politically motivated. 
 "Whenever the court enters the political thicket, it does so at its own peril," she said. 
 Later that day, Perry attended a seminar for teachers at the court, and when she emerged, after the bustle and emotion of the morning, the place had returned to its natural state. 
 The marble halls were empty; all was quiet. Even the plaza outside was deserted, save for a couple of television reporters completing their stand-ups. Rain began to sprinkle, she said, and then they left, too. 
 Writer <a href="/topics/Robert_Barnes">Robert Barnes</a> has covered the Supreme Court for the Washington Post since 2006.

OPBARN28

Barnes: Court sees rare moment in spotlight

Supreme Court Cropped

Analysis of the Supreme Court's health care decision

Newsday

Gallery: Analysis of the Court's health care decision

us supreme court health care cropped - vp

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Hard questions follow California fires

Either way, president-elect's comments on Greenland and Panama are risky business.

Trump outrage or shrewd maneuvering?

Studies showing extent of issue can guide a serious and thoughtful conversation.

Make reality base for transgender care

Drive to register Orthodox Jewish voters as Dems could affect NYC mayoral race.

Adams, Cuomo have started sniping

To break the cycle, we must answer hard questions about the perpetrators of violence.

Peace is but a dream in this new year

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Long Island gets grayer as younger people leave, data shows

Early intervention efforts can succeed only if service providers have the funds they need.

Get fair pay to disability aides

Current systems are too risky; let's wait for the next generation of technology.

Two views on battery storage

We must adhere to industry standards to ensure that our communities are safe.

Two views on battery energy storage

Private equity is lobbying to get access to Americans' retirement accounts.

Private equity does not belong in your 401(k)

More can be done to remind people of what constitutes a standard-size drink.

It's time to rethink how safe alcohol is

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Musings: Driving laws need intensive review

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Musings: School shootings affect so many

Musings: Helping those who face challenges can be joyful

Suffolk County Community College should rethink its decision to cut its offerings.

Protect LI's local journalism programs

Case in Congress reminds us that forced retirement based on age is unfair and unwise.

Dementia not an inevitable part of aging

America should learn the lessons of COVID-19 and act to thwart another pandemic.

We must prepare now for avian flu

Blakeman goes from telling Hochul 'stay out of LI' to 'we're going to need help'

President-elect Donald Trump took to Truth Social to call Newsom "incompetent." 

Presidents shouldn't play politics with wildfires

Congress knows that presidents have enormous leeway in declaring an emergency.

Yes, Trump could declare an economic emergency for tariffs

U.S. Merchant Marine Academy, Holtsville animal preserve, rabid raccoons, more

These 49 Regeneron scholars show what's possible with curiosity and drive.

LI's students always inspire

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