Dr. Malia Reckons

I have had a busy couple weeks in the office (thankfully) so I have not had time to post on the blog. But my thoughts and perspectives are building, and one of these days the dam may break! I guess I'll just have to focus on a handful of brief posts and limit my diatribes. So, late this evening, just before bed, I wish to make a simple connection of the United States Constitution and the current health insurance reform debate.

Today, September 17, is Constitution Day in the United States. On this day, 222 years ago, the Constitution was signed by the representatives of the states thus forming a "more perfect union" than the Articles of Confederation before it. That Constitution was the boring part that explains how the federal government would be shaped and function. The Bill of Rights, the first ten amendments of the Constitution, which I would say is better known today, would not be passed until March 4, 1791, about two years after George Washington had taken office, and a year and one half after the first Congress had proposed the first set of amendments to the states (there were twelve offered, but two were not ratified, so the Bill of Rights had just ten amendments). A very good website with transcripts, images and plenty of interesting bits of history and information about the Constitution can be found at http://www.archives.gov/exhibits/charters/constitution.html

So today is a fine day to reference the Constitution in relation to the current health insurance reform debate.

There is a comment I hear mentioned from time-to-time in the media, most often by folks at demonstrations against the reform efforts, that I find asinine. The basic idea is: "Where in the Constitution does it say Congress can change our health care?!" or "what makes Congress think they can make these changes?!"

Honestly, to me this is a ridiculous question and suggests the person asking it has not tried to check the answer him/herself. Also, I believe it demonstrates how many people think of the Bill of Rights as the Constitution and do not understand that those were just the first ten amendments and have nothing to do with the original document.

Having spent the last hour or so reading the Constitution (OK, I admit it, some sections were perused while others were looked at more closely, but I did get through it), I am happy to point out the two sentences I feel make it absolutely obvious that Congress does have the right to address issues with our nation's health insurance and health care industries. Whether they should or not I feel is a reasonable debate, but I do not think there can be a question they have the right to.

First, see the first sentence of the Constitution: "We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America." (emphasis mine)

If one of the primary goals of the Constitution is to "promote the general Welfare," then I certainly would argue that taking measures in an effort to expand access to medical services or to make more affordable those services that improve health and well-being while often lessening suffering and allowing our citizens to maintain their optimal quality of life should be included.

Second, see Article 1 (which pertains to Congress), Section 8: "The Congress shall have Power ... To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;"

Considering that health care in the United States currently is about 16% of our entire economy (about US$2.5 trillion), a sum and a percentage that the Founding Fathers likely could never have fathomed, I certainly believe it is "commerce" of sufficient size, which also is "among" the states that Congress should have the right to make efforts at shaping it, and, hopefully improving it so as to "promote the general Welfare."

Now, as I mentioned, I do think a debate of how Congress should make changes to the health insurance industry, or if they should do it at all, is worth having. But, please, let us move beyond the asinine idea that the Constitution does not give Congress the right to make relevant laws.

And with that, please, stop the ludicrous idea that the 10th amendment has any relevance. Yes, it says, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." But since the Constitution does delegate such power to Congress, it is ridiculous that any politician should speak of it as an actionable plan for a state to ignore a federal health insurance reform law that might be passed. And, sadly, too many ignorant Americans are getting riled up by this bunk.

Let us have a reasonable discussion of the issues, but let us stop wasting time on nonsense.

Happy Constitution Day!

Read it, discuss it, live it, love it!

--Timothy Malia, MD