Abstract
To the outsider, the American legal system is thoroughly intriguing—bizarre at times yet also marvelous. The process for deciding whether the individual mandate to purchase health insurance is constitutional under the Commerce Clause is no exception. The US Court of Appeals for the Washington, DC, Circuit recently found the mandate to be constitutional.1 Previously, appeals courts have found the individual mandate to be constitutional (6th Circuit) and unconstitutional (11th Circuit), both in 2-to-1 decisions.2,3 Although the legal process is fascinating, the premises used in legal arguments have to align with clinical, biological, and ethical realities. In this regard, it is necessary to scrutinize the core justification for the constitutionality of the mandate.
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