Health insurance didn’t even exist for almost another 100 years after the Constitution was ratified, so it stands to reason that the ‘founding fathers’ had no concept of it at the time.

I originally wrote this in response to a Facebook comment on Henry Koren’s thread asking about the meaning of “general welfare” in the Constitution and how it affected the Healthcare Reform debate. He reprinted my comment, with my permission, on his blog, and I’m reprinting it here too.

The Constitution was written over two centuries ago and is an actively re-interpreted and occasionally amended document. The Supreme Court exists specifically to interpret the Constitution within the context of modern situations that are not always clearly covered or even conceived of under the original language of the document as written. Health insurance didn’t even exist for almost another 100 years after the Constitution was ratified, so it stands to reason that the ‘founding fathers’ had no concept of it at the time.

Furthermore, there were 2 schools of thought even among the writers of the Constitution: the Madisonian, or “doctrine of strict construction” and the Hamiltonian, or “doctrine of implied powers.” The Madisonians believed the government should be strictly limited to the responsibilities directly enumerated in the Constitution. The Hamiltonians believed that the Federal govt could levy new taxes and spend money outside of the strict limits of the Constitution if it improved the general welfare of the people in a broad sense.

In 1936, the Supreme Court sided with the Hamiltonian interpretation, stating “the power of Congress to authorize expenditure of public moneys for public purposes is not limited by the direct grants of legislative power found in the Constitution.”

In 1937, upholding the constitutionality of a federal unemployment compensation program along with the Social Security Act, the Court further stated that “the conception of the spending power advocated by Hamilton… has prevailed over that of Madison.” and that a situation had developed (with respect to unemployment) wherein “the states were unable to give the requisite relief. The problem had become national in area and dimensions. There was need of help from the nation.”

On that same day the Supreme Court upheld the joint federal/state cooperation necessary to make the Social Security and unemployment programs possible.

As a constitutionally-formed body that exists to interpret the Constitution as it applies to new situations and context, the Supreme Court’s body of decisions carry the full weight and power of the Constitution itself and can only be overturned by subsequent decisions of the Supreme Court or by constitutional amendment. As such, it makes little sense to return to the “original document” when we have more recent and constitutionally valid body of precedent to serve us, and when even the writers of said document were not in agreement over the scope of the government’s powers.

It seems clear to me that the 1936-7 decisions gave the Federal government broad power to spend for the general welfare and then indeed DID define “general welfare” to include the relief of its citizens, especially when situations arise such that individual states are unable or unwilling to provide relief, and the problem is national in “area and dimension”. Further social welfare programs by the Federal government have survived constitutional challenges, no doubt in no small part thanks to these SC decisions, and this only further cements that the US govt has the right and responsibility to act for the general welfare in a broader sense than originally outlined by the Constitution or supported by the Madisonian school.

The issue, then, becomes whether one believes health care has become a problem that is national in scope and intensity, and whether the federal government should act to address the problem directly, but I think the Supreme Court’s decisions and the continued existence of other federally-supported social welfare programs confirm that such action is indeed supported by the law of the land and that the federal government is well within its jurisdiction to implement remedies.