Today, for a third day, the Supreme Court will continue to hear arguments regarding the constitutionality of the Affordable Care Act. Crowds pack the courtroom; protesters swirl around outside; and those of us farther away are hearing same-day audio broadcasts of the proceedings, a rarity. If nothing else, this event shows how knit together we’ve become as a nation. As a capital, Washington DC used to be mocked as a place out of sight and far from the minds of the people; today it’s at the center of things, a nucleus of discourse and controversy.
The case is a landmark in another way. There’s a lot of hype about it, and passions are keen on all sides. Everyone understands something momentous is happening. Unlike many Supreme Court decisions, which concern distinct subsets of people—union workers, say, or pregnant women, or juveniles in prison—, this one will affect all Americans directly. Perhaps that’s what gives the proceedings a different feel. Will we end up with a single integrated health-care system that acknowledges and includes us all, or will we continue with the old balkanized system that denies the fact that we are connected through it already? Because, one way or another, we do already pay for the care that the uninsured need, and bear the indirect costs of their being ill, if you are inclined to monetize issues that way.
To strike down this complex and undoubtedly imperfect legislation would be undoing change that is happening already; more to the point, it would re-affirm Americans’ separatist tendencies: our determination to go it alone no matter what the costs or consequences. On the other hand, should the constitutionality of the Affordable Care Act be affirmed, we will find ourselves on a new road together, engaged in a massive and complex experiment whose likely outcomes are truly unknown.