This week sees President Obama’s key domestic achievement on trial. In a particularly American expression of democracy, the Affordable Care Act, or what opponents call 'Obamacare" is not being put before the electorate.
Instead, the President's reform of healthcare is before the Supreme Court.
Twenty-six states (and a lobby group representing small businesses) have challenged the federal law – signed in 2010 – that planned to revolutionise healthcare in the United States. Reform remains divisive and most of it is along political lines.
Obama's plan includes a requirement that people obtain compulsory health insurance by 2014 or pay a penalty. Important point: healthcare in the United States is not, for most of the population, supported by the government in the way it is in Australia.
Mostly, people take out private insurance that is costly and complex, inefficiently managed, exclusive (insurance providers can deny you coverage for a pre-existing condition) but also extremely profitable and lucrative for the insurance companies.
Some, including the President, believe the system is broken and want to fix it. Others, mainly Republicans, want no change.
A key component of Obama's plan, already signed into law, is that health insurance is compulsory. Currently, many people do not take out insurance because they can't afford it or see no need. Then they get sick. They then use healthcare that a hospital, by law, must provide and which costs are passed on to those who do pay insurance.
The compulsory insurance factor is a key trigger in forcing insurance companies to take on customers who have pre-conditions. But opponents claim – and are arguing in front of the Supreme Court – that the requirement is unconstitutional based, they say, on the idea that the government should not be able to “regulate commerce”, or force people to buy something they don't want.
Americans are big on individual rights. Political arguments will often swerve toward that argument and it will trump any concern for social contracts assisting those well off. Hard up? Can't break out of poverty? It will be argued that you should work harder – get two or three or four jobs. Be responsible for yourself. A society's helping hand is often confused with “Socialism”.
The courts ruling on this issue is due in June. It should provide an election year boost for Obama – or a massive blow in his campaign. The court, that swings marginally Republican, has a few options.
It could uphold the law, agreeing the government has the right to demand Americans buy health insurance.
It could throw out the entire Affordable Care Act, dropping a bomb on Obama.
Or, it could screw reform and make it unmanageable by ruling compulsory insurance is unconstitutional but not the entire Affordable Care Act and send Obama back to the drawing board. This, as well, would be an Obama slapdown.
Here's a link to some views on how the legal argument may play out. Read the comments, too.
The case has prompted over six hours of oral arguments to be scheduled for the issue. This is the biggest allocation of time for a case in over 40 years, demonstrating either the passion for the debate, complexity of the issues, the amount of hot air we're likely to feel blow our way, or the size of the lawyer's fees.
One argument, however, maybe breaks this down in a way many Americans can relate. The government makes you pay insurance for your car, right? And everyone agrees to do that. What's the big difference with health insurance?
A lot and not much, apparently. If you don't want to take out car insurance, don't drive a car. If you don't want health insurance, drop dead. Of course, nothing in America is ever that simple.