What happens when social justice runs afoul of a strong constitutional argument? Judges earn their pay.

When it cannot be resolved in the lower courts, the conflict lands in the laps of the nine justices of the U.S. Supreme Court, who may render a judgment or may send the case back to a lower court with guidance for reconsideration.

Such is the case with the recently passed federal health care law that requires citizens to buy health insurance or pay fines. Two federal judges in the lower courts have sustained the controversial law and two have ruled against it. The issue seems destined for the high court.

At stake is a fundamental question: In the United States, should citizens be denied health care if they cannot pay for it? Said another way, should everyone be entitled to health care? If we are entitled, then how do we pay for it?

While the high court’s job is to rule on constitutional issues, it is the job of Congress and the president to resolve the dilemma of social policy. It’s all about how we choose to see the role of government in our lives.

Take a minute to pick your way through this quote attributed to Abraham Lincoln: “The legitimate object of government, is to do for a community of people, whatever they need to have done, but can not do, at all, or can not, so well do, for themselves in their separate, and individual capacities.

“In all that the people can individually do as well for themselves, government ought not to interfere. The desirable things which the individuals of a people can not do, or can not well do, for themselves, fall into two classes: those which have relation to wrongs, and those which have not. Each of these branch off into an infinite variety of subdivisions.

“The first that in relation to wrongs embraces all crimes, misdemeanors, and nonperformance of contracts. The other embraces all which, in its nature, and without wrong, requires combined action, as public roads and highways, public schools, charities, pauperism, orphanage, estates of the deceased, and the machinery of government itself. From this it appears that if all men were just, there still would be some, though not so much, need for government.”

Lincoln comes to the crux of the argument as to the scope and role of government in our modern era. saying “if all men were just,” Lincoln nails the debate that so divides our nation. It’s about justice.

But does a degree of injustice permit Congress to force individuals to buy something they may not want? Though Lincoln doesn’t answer the question, he certainly sets the stage for the debate.

It seems that decency, if not the law, ensures that people in need of emergency health care will be served at our hospitals.

If they cannot pay, the cost of those services is simply passed to the government or those who have health care insurance. One way or the other, the bills get paid or the hospitals and doctors go out of business.

However, delivering health care in an emergency room is the most expensive and least efficient means of treatment.

It also fails to address the ongoing treatment necessary for chronic conditions and diseases, ensuring return trips to the emergency room.

The basis of insurance is to spread the risk and payments across as many people as possible to ensure the bills get paid, particularly for the few who have catastrophic illnesses.

Taxes accomplish the same objective in terms of spreading the responsibility for payment.

It seems clear that we have to figure out how to pay for it so the burden does not fall unfairly upon those who pay for themselves in addition to the surcharge they pay for those who do not or cannot pay for their health care.

The resolution may be that a tax on the entire population is necessary or it could be that the court will uphold the requirement that all people buy insurance from a private insurance company.

Under either circumstance, it is critical that we resolve the constitutional issue, as that is the governing document of our democratic experiment.

If the health care law is struck down and Republicans win back the White House and take control of the Senate in 2012, they should honor Lincoln by demonstrating that their solution is just and will thus preserve the limited government he envisioned.

If they cannot or will not render a solution, then they will deserve to be turned out of office.

No matter who wins, the health care cost crisis needs to be resolved once and for all.

What do you think, and what are you going to do about it? 

Tony Payne is a lifelong Maine resident active in business, civic and political affairs. He can be reached at:

tpayne@maine.rr.com