The Constitution Basis for a Federal Health Care System

Having now outlined my fundamental views on the Constitution, this post seems a bit superfluous. But perhaps it will serve as a useful example. In case you’ve forgotten by now, this is part of a series on health care. You can find the initial post and links to the others in the series here.


As a first proposition, let me say that I find nothing in the Constitution expressly limiting the establishment of a federal health care system per se. There are certainly ways of doing so that would violate the Constitution. For instance, the Constitution explicitly forbids slavery. Short of that, the 5th and 14th amendments protect the labor of medical professionals from being taken against their will. They also, as I read them, would prohibit systems that were intended to treat U.S. citizens in a discriminatory fashion (thereby denying equal protection).

I’ve previously outlined my reasoning for such a system based on the principles in the Declaration of Independence. As far as the Constitution, I would point to three clauses from the preamble as legitimate reasons for pursuing a federal system:

  • “To … promote the general welfare” — As I’ve explained elsewhere, I do not think that efforts to promote the general welfare must necessarily be limited to non-redistributive measures. The federal government can reasonably act upon the national economy in ways that will promote the national good.
  • “To … secure the blessings of liberty to ourselves and our posterity” — I think one of the roles of government is to mediate between the capitalist and citizenship systems within our society. In that reading, it is reasonable for government to transfer some of the economic strength arising from our capitalist system (“the blessings of liberty”) and secure them for the people on a citizenship basis. Health care strikes me as ripe for that transition.
  • “To form a more perfect union” — Right now, our state-based regulatory regime is a mess. It simply doesn’t align with the realities of the national economy. Personally, I think we’re past time for health care to transition from state to federal jurisdiction (as it already has in the areas of drug regulation, medical devices, and others).

Whatever the exact form a federal health care system took, it would rely on at least these powers specifically innumerated in the Constitution and granted to Congress:

  • The power “to regulate Commerce … among the several States” — While I regard this clause as a somewhat problematic basis for the ACA (with it’s ‘mandate’ provision), it would be an essential pillar of a truly federal health care system.
  • The power “to lay and collect Taxes” — Any federal system will require revenue. My proposed system would be directly taxpayer-funded, so it would rely on the powers as clarified by the 16th amendment.
  • The power “to make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers.” If the commerce clause grants Congress powers over the national economy like those they have used for more than 100 years, then there is certainly sufficient power for regulating the national health care system. There is also power to tax in support of such a system. These being the case, Congress must also have the power to regulate the health care through the establishment of a federal health care system.

Those are my thoughts on the Constitutional basis for such a system. In my next (and last) post in this series, I’ll detail what I see as some of the benefits of a national health care system for our capitalist economy.


This is the sixth post in a series explaining why I favor a national health care system. For the introduction to the series and a list of the posts, click here. Or, for all my health care related posts, see here.

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