Health care law: Everyone loses without reform

There's no courtroom big enough, of course, to hold all the Americans with health insurance who are reaping the early benefits of the federal health overhaul. But their interests - and those of 30 million uninsured citizens - are integral to the legal drama unfolding this week, as the Supreme Court hears arguments in a lawsuit seeking to overturn the reform.

While the second anniversary of the landmark legislation finds the law under siege, it also brings proof that the reforms are already improving the lives of millions.

In this tri-state region, that includes 375,000 seniors now saving on drug costs, another 2.6 million people who received free preventive-health screenings, and the nearly 140,000 young adults who were brought under their parents' insurance plans. Thousands of small businesses, as well, have utilized federal tax credits to help them provide their workforce with health insurance.

Meanwhile, the justices hearing six hours of arguments over three days may be focused on just one citizen - a long-dead Ohio wheat farmer. In Roscoe C. Filburn's failed 1942 challenge to a federal penalty limiting wheat production, though, the justices have their answer to the constitutionality of the Affordable Care Act provision requiring most citizens to get insurance.

It's not a legal slam dunk, but the idea that Washington legally can levy a penalty over crop limits seems to be little different from imposing a tax surcharge for not obtaining health insurance.

That much-maligned insurance "mandate," decried as downright un-American by Republicans, conservatives, and some business interests, in fact, isn't a mandate at all. The law merely establishes a cost for not buying insurance, in the hope that most citizens will come around to the sensible idea that - since everyone needs medical care at some point - it's in the national interest that everyone has health insurance or shares in its cost. (Those who truly cannot afford it would receive subsidies, or government-paid care under Medicaid.)

Since the health-care sector accounts for 17 percent of the economy - and with costs galloping for decades - it's unarguably an issue of interstate commerce in which Congress can set the rules.

That's how the high court should rule. Yet, whatever the outcome, the fact remains that health reform is the only option, if the nation hopes to tame a cost spiral that threatens not only Americans' financial security but their very well-being due to the quality of medical care.

There's no dispute that those without health insurance will likely get care later due to an illness, even to the point of risking early death. The devastating impact on their family finances is borne out in the number of bankruptcies driven by medical expenses. Ironically, the lead plaintiff in the ACA challenge - a former small-business owner - went bankrupt last fall citing $4,500 in unpaid medical bills.

For all the focus on the so-called mandate, the Republican case against health reform amounts to Cassandra-like predictions of runaway costs, employers dropping coverage, and more people going uninsured. That, however, is the more likely future without reform.

Indeed, the GOP's alternatives - "market-driven solutions" in its talking points - have been shown to be completely inadequate to the task of insuring the millions who need coverage. That hasn't changed in two years, which exposes the opposition as a proxy for opposing President Obama's reelection.

Pushing ahead with the health-care overhaul isn't about any one politician's career, though. It's about what's best for the nation.