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Why Supreme Court's CA Prison Ruling is Good for Health Reform

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Inmates at Chino State Prison, California
Inmates at Chino State Prison, California
Kevork Djansezian/Getty Images

Yesterday's Supreme Court decision mandating that California free 46,000 inmates from its cruel and unusual prison system is one of the most liberal decisions to emerge from the Roberts court. Considered primarily as a ruling about health care, it ought to boost the spirits of Obamacare defenders.

Writing for the majority, the Court's swing justice, Anthony Kennedy, stakes out a vision of government power and responsibility as it relates to health care that could easily have been penned by his former liberal colleague justice Stevens:

To incarcerate, society takes from prisoners the means to provide for their own needs. Prisoners are dependent on the State for food, clothing, and necessary medical care. A prison’s failure to provide sustenance for inmates “may actually produce physical ‘torture or a lingering death.’” Just as a prisoner may starve if not fed, he or she may suffer or die if not provided adequate medical care. A prison that deprives prisoners of basic sustenance, including adequate medical care, is incompatible with the concept of human dignity and has no place in civilized society. 

To give you a sense of how out of step Kennedy's expansive legal reasoning is with the views of the right-wing justices whose decisions he habitually joins, look at the pissy dissent written by Justice Scalia (co-signed by Justice Thomas). Scalia calls the majority's invocation of the Eighth Amendment ban on cruel and unusual punishment "preposterous" because not all inmates suffer equally; the California penal system is also "undoubtedly" populated, Scalia writes, by "fine physical specimens who have developed intimidating muscles pumping iron in the prison gym."

A competing dissent from Justice Alito (co-signed by Roberts) reasons that the heinously inadequate health care delivery in California prisons must be judged against the heinously inadequate health care delivery that many non-incarcerated Americans endure:

The population of the California prison system (156,000 inmates at the time of trial) is larger than that of many medium-sized cities, and an examination of the medical care provided to the residents of  many such cities would likely reveal cases in which grossly deficient treatment was provided.

This case matters not just because it will bring overdue reform to California; it also tells us something important about Justice Kennedy's views on health care.

To uphold Obamacare's mandate that all individuals must purchase insurance or pay a fine will require an expansive reading of the commerce clause of the Constitution. 

And certainly, a justice who believes that provision of adequate medical care is a prerequisite for a "civilized society" is more likely to look favorably on federal efforts to ensure a functional health care insurance market. The court's swing justice has signaled here that he believes health care is no ordinary consumer good. To justice Kennedy legal mind, adequate health care is squarely a question of "human dignity." 

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