Healthcare reform tussle, seen through the lens of Constitution Day

How the various branches of government are adhering to America's founding document.

If this year's Constitution Day needs a poster child, perhaps it's the healthcare reform effort under way in Washington.

America's founding document set up the balance of powers among branches of government – and the process of devising healthcare legislation, which has grabbed the attention of many citizens, provides a lens through which to examine their actions thus far.

Here's a quick summation of their roles:

The executive branch. This comes second (after Congress) in the Constitution, but it has become the norm for the president to play a leading role when major legislation is at stake. On healthcare, Congress is working the issue partly because the White House has decided that "Now is the time to deliver on healthcare," as President Obama put it this month. After first coaxing lawmakers to craft bills, and seeing momentum stall, Mr. Obama in a Sept. 9 speech sought to take a stronger role in shaping the reforms.

The legislative branch. Much as Obama might wish for fellow Democrats in Congress to coalesce around his ideas, this first branch of the US government is its own animal. And kind of a Pushmi-pullyu at that. The Founding Fathers set up checks and balances not only among the various branches, but also within the legislative branch. For any bill to pass, it will have to navigate the very different political and procedural dynamics of the House and Senate. The Senate could hold the key on healthcare, since it is more narrowly under Democratic control than the House. That explains why the news this week is dominated by something called the "Baucus plan," not the Obama plan. The clout of Sen. Max Baucus (D) comes not from a massive voting bloc in his home state (Montana has less than a million people) but from the time-honored system of committees and legislative dealmaking. Senator Baucus's framework won't be the last word, but it's getting more than 15 minutes of fame.

The judicial branch. Any major healthcare overhaul could face legal tests of constitutionality. Some state-level healthcare reforms have already run into judicial roadblocks. One hurdle at the federal level could be privacy rights, for example, if government rules place an "undue burden" on the ability of patients to get care they want, legal experts David Rivkin and Lee Casey argued recently in The Wall Street Journal.

People power, too. Of course, the Constitution's preamble starts not with any of the three branches, but with "We the people." From journalists who fact-check the claims of policymakers to voters who get to render their verdict on policy every two years, the healthcare debate is heavily influenced by powers outside official Washington. Plenty of lawmakers are keeping an eye on public opinion polls as they consider how to vote on this issue.

Despite the republic's high ideals, the health-policy free-for-all is a reminder that some voices are heard more loudly than others. That was true in 1787, when most of the adult population couldn't vote. And it's true today, when the lobbying arms of insurance firms, medical associations, and labor unions are prominent players in the debate.


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The long-awaited Baucus healthcare plan takes flak from the left and the right.


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