The fate of federal health care reform may well rest on how the U.S. Supreme Court addresses a philosophical problem: Is human freedom more or less a capacity to choose, no matter the context or purpose of the choice? Or is human freedom best considered a capacity to choose inescapably rooted in a context and always for some purpose?
A big brain teaser, to be sure, but one that has very practical consequences. If human freedom is just a capacity to choose, then the individual mandate at the heart of health care law is obviously an arbitrary exercise of government power that should be struck down. As this line of thinking sees it, people should be free to choose, whatever their choices are. The mandate contradicts such freedom by compelling the purchase of health insurance for an already defined purpose: to serve the overall efficiency of the national health care market. Thus this critical view of the mandate thinks: Today the government will compel people to buy health insurance; tomorrow it might be broccoli; the next day, cell phones (to draw on examples used by conservative justices during the health care arguments before the court).