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The arguments of both sides in front of U.S. Supreme Court Justices on the Health Care Law's expansion of Medicaid. Justice Scalia said the law gives the states no choice. Justice Kennedy pointed to the situation of the states which have no way to opt out without stripping millions of Americans of medical care. Justice Roberts pointed to the states willingness to accept federal aid for years which brings us to the current situation. The attorney generals of 27 states have objected to the Health Care Law's provisions which they believe effectively requires the states suffering tight budget constraints to cover more of the poor than they they think they can, with the alternative being dropping out of Medicaid totally, not giving them much of a choice. As the three day hearing came to a close on March 28, 2012, the Supreme Court's conservative Justices expressed doubts whether the Obama Health Care Law could surivive if some key parts are struck down. With Justices Sotomayor, Ginsberg, Kagan, on one side, and Scalia, with other conservative Justices on the other side, the Court's final decision depends on Justices Kennedy and Roberts. ...

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This WSJ editorial describes the choices facing states in the U.S. for Medicaid- staying in and increasing the strain on state budgets or opting out altogether from Medicaid when hospitals in the states have enlarged their Medicaid dependent programs- as being a kind of extortion. Justice Kennedy said this was not giving the states much of an option, and Justice Scalia described it with a Jack Benny humor quote about being held up by a robber saying "your money or your life." Justice Roberts described the overwillingness of states to accept federal funds that got them to this point. The overall sense of the hearings at the U.S. Supreme Court on the third day, was that of skepticism on the part of Justices Scalia, Alito, Kennedy and Roberts, leaving Solicitor General Verrilli to make an appeal to humanitarian and patriotic sentiment about millions of the poor who would go without medical care if the Court ruled against the government.

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Hangzhou, hard hit by closing export focussed factories, is trying a$100 million voucher program to increase spending. Since January, a fifth of the residents of this city have received $30 vouchers, and more vouchers are being issued. Taiwan just tried a voucher program with $102 going to each Taiwanese citizen. Taiwanese President Ma says 50,000 retailing jobs were saved and about two-thirds of one percent addded to GDP. The problem in China is the lack of a safety net and poor access to health care, that is making average Chinese to save over one fourth of incomes. Consumer spending is 35% of GDP. The government has focussed on exports, and used export generated revenues for huge infrastructure spending. With exports down by over 25% in January, the export model is fading away quickly. Japan and Taiwan have seen much higher drops in exports, and China should see even more deceleration in exports, with a lag of some months, as a lot of products made in China use parts made in countries like Japan and Taiwan. The China Development Research Foundation says one fourth of the population have no health insurance at all. Though by some estimates this number may be about two thirds of China's 1.3 billion people. Hundreds of millions of people have huge bills for treatment of serious illness that are not covered by even the most basic insurance. Public pensions cover less than one third of the workers. And an estimated 130 million migrant workers have no unemployment insurance. Even payments to the poor reach only a fraction of people eligible. The government has only tentatively moved to correct his. And outside economists say that something needs to be done in abig way to build this safety net. The government has announced a $123 billion 3 year initiative to deliver basic, universal health care and health insurance. This follows a 3 year drive to provide compulsory and free education to students through 9th grade. David Dollar, the World Banks's country director, described ameeting with Finance Ministry officials, and wrote in areport on the Bank website that the government had the resources to expand these programs quickly. Instead the government has taken a piecemeal approach when action on a large scale is needed. One of the problems may also be that to make universal health insurance, the current health system may need to be examined and rebuilt, so that economical cost effective treatments are encouraged and costs are managed effectively. This would make universal health care affordable by keeping costs manageable, in the same way that the Obama administration is trying to do in the USA. ...

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Arguments that are expected to be used by both sides before the U.S. Supreme Court on the health care law. At the heart of this is the 1942 decision, Wickard v. Filburn, on the limits of federal power. Mr. Filburn, was an Ohio farmer who questioned a 1938 federal law that imposed a penalty on every extra bushel of wheat on his farm beyond the stipulated amount. The decision was unanimous and went against Filburn. At issue is whether the federal government can impose a penalty on individuals for not buying health insurance. Justice Robert Jackson wrote in that case: "Even if appellee's activity be local, and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress, if it exerts a substantial economic effect on commerce." The Obama administration's argument in its brief is that the decision of individuals not to buy insurance, like that of Filburn to plant that extra bushel, has larger effects beyond the local one and serious consequences for the whole country- it raises insurance rates of people in states across the country and makes hospitals bear the burden of caring for these uninsured people. For over 50 years the Supreme Court has largely supported the idea behind the Filburn decision, except in 1995 and 2000- these two decision invalidated laws made about guns near schools and violence against women. The Court ruled that the activities were local and noncommercial and beyond the federal power to regulate interstate commerce....

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President Obama told a press conference after the Supreme Court hearings on the healthcare law: "For years, what we've heard is the biggest problem on the bench was judicial activism or the lack of judicial restraint, that an unelected group of people would somehow overturn a duly constituted and passed law." In doing so Obama was framing the argument he might use should the Court rule against the law, putting the Supreme Court in the role of villain placing its judgement ahead of elected representatives, as the U.S. moves into the presidential election in November 2012.

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Ann Matthews describes how the U.S. Supreme Court ruling on the Obama health care law affects 4 managers in the health care industry and U.S. businesses.