Health care reform and the general welfare clause

One of the questions guiding the discussion over health care reform is part of a larger, more fundamental debate that has been going on in America since before the ratification of the Constitution: what is the proper role of government? In the current context, constitutional scholars point to the General Welfare Clause in Article 1, Section 8, Clause 1 (bold emphasis mine)::

The Congress shall have power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States

Mainstream constitutional interpretation reads this as a direct grant of power to Congress to spend money on anything it deems necessary to secure the general welfare, including programs of social insurance. Since Social Security was judged constitutional by the Supreme Court in 1937 in the cases Steward Machine Co. v. Davis and Helvering v. Davis, the General Welfare Clause has been seen as a broad grant of power to the Congress to spend money for purposes that benefit the country as a whole. While this clause is not interpreted as enabling Congress to legislate in the internal affairs and governance of the States, it does provide Congress broad discretion in the areas that it can spend federal money. So long as funds are not spent for purely local purposes, Congress is not limited on the types of programs and projects for which it can appropriate.

But this was not the original principle upon which the Constitution was founded. James Madison and Thomas Jefferson envisioned the Constitution as granting specific, enumerated powers to the federal government, as detailed in Article I, Section 8, Clauses 2 through 17. The general welfare for which Congress could expend revenue in Clause 1 was limited by the rest of Article I, Section 8. Otherwise, as Madison posed the question in a letter to Andrew Stevenson, "why, on that supposition [that the phrase general welfare provided expansive powers to the Congress], so much critical labour was employed in enumerating the particular powers, and in defining and limiting their extent?"

Madison was arguing against the more expansive interpretation of the General Welfare Clause pushed by Alexander Hamilton, as classically expressed in Hamilton's 1791 Report on Manufacturers:

The terms "general Welfare" were doubtless intended to signify more than was expressed or imported in those which Preceded; otherwise numerous exigencies incident to the affairs of a Nation would have been left without a provision. The phrase is as comprehensive as any that could have been used; because it was not fit that the constitutional authority of the Union, to appropriate its revenues shou'd have been restricted within narrower limits than the "General Welfare" and because this necessarily embraces a vast variety of particulars, which are susceptible neither of specification nor of definition.

Although the Madisonian interpretation of "general welfare" was the overriding perspective throughout the nineteenth century, Hamilton's view was the interpretation that finally won out in the Supreme Court's Steward Machine and Helvering cases. Because the federal programs that have grown out of the New Deal augmented and, in many cases, overrode founding principles, fundamentals of constitutional interpretation have been irrevocably changed through the political process set up by the Constitution itself (a move that falls within the structure of the Governance Imperative, but a move, nonetheless, aided by the passage of the Seventeenth Amendment and the loss of the States to their direct representation in the federal legislative process). Because of what the vast majority of the American people now expect, it must be conceded that health care reform would fall within the purview of the general welfare, even though the concept of governmental welfare was poisonous to society in the view of the founders.

Benjamin Franklin's wrote in 1776 in his On the Price of Corn and Management of the Poor:

I am for doing good to the poor, but I differ in opinion of the means. I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. In my youth I travelled much, and I observed in different countries, that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer.

A principle even more fundamental than enumerated federal powers animates the American engine even today: each man is able to apply his talents and contribute to the marketplace as he is able, retaining for himself the fruits of his labor. What a man earns is his own and is not subject to government seizure and redistribution. Jefferson wrote in a letter to Joseph Milligan in 1816:

To take from one, because it is thought that his own industry and that of his fathers has acquired too much, in order to spare to others, who, or whose fathers have not exercised equal industry and skill, is to violate arbitrarily the first principle of association, "the guarantee to every one of a free exercise of his industry, and the fruits acquired by it." If the overgrown wealth of an individual be deemed dangerous to the State, the best corrective is the law of equal inheritance to all in equal degree; and the better, as this enforces a law of nature, while extra taxation violates it.

Whether we are ready to move another step beyond this first principle is at the heart of the health care reform debate, but there are no constitutional barriers to health care reform's passage.