Behind closed doors, the U.S. Supreme Court is deliberating the fate of the ACA (an abbreviation for the Patient Protection and Affordable Health Care Act of 2010).  Their primary question is the constitutionality of Congressional regulation of healthcare as interstate commerce.  We-the-Patients need to consider a larger and more practical question, one that will affect every single one of us: is health care commerce at all?

The ACA requires all citizens to purchase health insurance, with financial penalties if we do not.  Interestingly, illegal residents are exempt from this penalty.  The core question for the Supreme Court is discussing whether there are any limits to federal control of commerce?  Can Washington regulate commerce that has not happened yet?  Can Washington penalize a citizen for not engaging in commerce?

Health care as two words refers to a service relationship between patient and provider.  Healthcare when used as one word is a system that is supposed to facilitate the two words -- health care.

Beware of politicians who use the word "insurance" interchangeably with the phrase "health care."  They want us to believe that one equals the other.  They are not synonymous.  Many people with insurance cannot get health care.  Many without insurance do get care.

Commerce involves the exchange of money for goods and services: buying and selling.  By that definition, health care is a commercial activity.  People called patients buy medical goods and services, almost always through a third party.  Other people (providers and institutions) sell medical goods and services to patients, also through a third party.

In healthcare (the system), payments from buyers (patients) and payments to sellers (providers) are predetermined.  Such transactions are not subject to market forces.  Commerce is based on a free market.  Thus, health care cannot be commerce.

If health care is not commerce, what else might it be?  Maybe it is a right.

Rights are ways to protect our freedom.  Look again at the Bill of Rights.  This list of our most basic rights is really a recitation of things the government should not do.  We have those rights as constraints on central authority in order to guarantee free speech, ability to congregate, practice religion, and "bear arms."  Having these rights costs nothing (other than the "blood of patriots").

You do not pay to have the rights to speak freely, to travel without a permit, to congregate, practice religion, or possess a firearm.  You pay to use these rights.

You pay people, such as social and broadcast media, to distribute your free speech.  To access your right to travel freely, you pay road builders and car dealers.  We all pay the police to protect us from those who would use their rightful firearms to harm us.

The activation and maintenance of rights, but not the rights themselves, require commerce.  If you want health care -- a service provided by others and goods made by others -- you must engage in commerce.  So, health care is commerce after all and not a right -- certainly not as envisioned by the U.S. Founding Fathers.

To have a right to "free" health care, one that involves no commerce, requires the government to enslave providers and to steal (take without payment) products made by private companies.  That is the precise opposite of what the U.S. stands for.  Health care in our country is and must be commerce.

Now that is settled, let's get to what really matters.  How do we provide the best health care supported by the best healthcare (system) to the most people in the U.S.?  Let's talk about that!

In 2008-2010, when we were having all those partisan debates, and watching the political maneuvers, arm twisting, bribery, outright lies, and deal-making over healthcare and the ACA, we missed an opportunity to talk about what we should discuss.  How do we provide the best health care -- service goods -- for the most people in our country?

It is not just individuals who would gain by having an effective U.S. healthcare system.  Our nation, what I call We-The-Patients, would regain its competitive advantage if we had a system that produced a healthy, long-lived populace.