The following is an interesting parallel written by Chris Fleming and appearing in the Health Affairs Blog.

If the Affordable Care Act’s requirement that individuals purchase health insurance is an unacceptable infringement on the liberty of Americans, is the requirement that Americans “purchase” Medicare with payroll taxes an equally unacceptable infringement of that liberty?  While one can argue that the two situations are distinct as a matter of constitutional law, the philosophical question remeains interesting, and over the past weeks, it has been discussed in many forums.

I put this question to Virginia Governor Bob McDonnell (R) today after an Aspen Institute forum on the ACA’s “individual mandate.” Governor McDonnell said it was a “fair question — I haven’t thought about that in great detail other than that [Medicare] has been around for 50 years and no one is going back and looking at that.” The governor said he would not advocate allowing people to avoid paying Medicare taxes by opting out of the program.

During the Aspen Institute forum, McDonnell argued that the mandate was not authorized by the Constitution, and former Pennsylvania Governor Ed Rendell (D) defended the provision’s constitutionality. However, while McDonnell and Rendell disagreed often on substance, they did agree on one important point of procedure: The Supreme Court should immediately take up the question of the ACA’s constitutionality, rather than waiting for the issue to percolate up through the appellate courts


The difference as I see it is that we as Americans have never been given the choice as to the disbursement of our taxes but rather have left that to those who represent us in government, trusting that they will have the wisdom to know what is best.  On the other hand, what we purchase with our own budget and finances at home, have always until this time, been controlled by us.

The lines are now becoming blurred.